Routine removal of neck lymph nodes during initial thyroid surgery for papillary thyroid cancer was associated with lower rates of disease recurrence, and decreased the need for follow-up operations, according to a study in Surgery (2011;150:1048-1057).
The retrospective multicenter cohort study pooled outcomes of 606 such patients across three surgery centers in Australia, the U.S., and England who had thyroidectomies. The rates of cancer recurrence in the patients who had also undergone central lymph-node dissection (CLND) as a routine addition to the initial operation (259 of the cases) were compared with those who had not (347 of the cases).
The need for central neck re-operation for patients whose lymph nodes were removed was 1.5 percent compared with 6.1 percent for those with thyroidectomies alone, reported the researchers, led by Michael Yeh, MD, Associate Professor of Surgery at the David Geffen School of Medicine at UCLA.
The effectiveness of CLND in preventing thyroid cancer recurrence has been raised and studied before, but this is the largest study to demonstrate these findings. “What's new about this is that we have 600 patients from three centers—and that's adequately powered,” Yeh noted in a telephone interview.
Even though a high number (up to 75%) of thyroid cancer patients have lymph node metastases, only a small percentage of those (about 25%) will develop a significant recurrence and require an additional operation. So, previous studies that evaluated the effectiveness of CLND have not been large enough to show the difference in outcomes, as this one did.
The next step is a prospective randomized clinical trial to study further outcomes of routine central neck lymph node removal in initial thyroidectomies, Dr. Yeh said.