Central Compartment Neck Dissection With Thyroidectomy
Central Compartment Neck Dissection With Thyroidectomy
When a patient presents with a thyroid mass, part of the work-up may include a fine needle
 aspiration biopsy (FNAB). The results of the biopsy then help plan treatment. If the results
 are benign, the management will typically be to follow the nodule. If the results demonstrate
 or are suspicious for cancer, such as papillary thyroid carcinoma (PTC), the treatment is a
 total thyroidectomy (total thyroid removal). The latest American thyroid association
 guidelines for PTC (2009) suggest that in many instances a central lymph node dissection
 (CLND) should be performed in conjunction with the total thyroidectomy. This procedure
 consists of removing the lymphatic (glandular) tissues surrounding the thyroid itself, as
 this tissue may have a propensity for cancer spread. The procedure's necessity has met much
 controversy in the last decade, but is becoming more of a standard in thyroid cancer surgery.

 When a thyroid nodule FNAB is reported as indeterminate, the treatment strategy is less clear
 cut. While a diagnostic hemi-thyroidectomy or therapeutic total thyroidectomy may be in
 order, the inclusion of CLND is not clearly defined. In many centers a CLND will be omitted
 with surgical management for an "indeterminate" lesion, while in others, it is standard
 protocol. The argument of performing CLND is largely based on the tenet that it adds little
 surgical time, cost or risks to the patient. Because the evidence of the prognostic role of
 lymph node metastases is limited many would argue that the risk of not performing CLND is
 greater than performing CLND. Furthermore, in the event of finding cancer on final pathology,
 and thus, having to re-operate in the thyroid/central compartment bed, post-operative
 complications may increase. Opponents of CLND argue that there is a paucity of strong
 evidence supporting CLND in the improvement of oncologic outcomes and can potentially
 increase post-operative low calcium levels or vocal nerve damage However, these
 recommendations are based on retrospective level III evidence. Thus the debate continues: is
 CLND justified as an adjunct to hemi-or total thyroidectomy in indeterminate thyroid
 pathology?

 The hypothesis is: CLND in hem- or total thyroidectomy for "indeterminate" thyroid nodules
 will not increase post-operative complications.
Inclusion Criteria:

 -  Indeterminate or benign pathology on fine needle aspirate biopsy

 -  Scheduled to undergo total or hemi-thyroidectomy

 -  > 18 years old

 Exclusion Criteria:

 -  Previous thyroid surgery

 -  Previous neck surgery in field of thyroidectomy

 -  Previous neck irradiation

 -  Pre-operative hypocalcemia or hypoparathyroidism

 -  Biopsy suggestive of thyroid cancer

 -  Neck nodes suspicious for or with known cancer

 -  Pre-operative vocal cord dysfunction