Routinely removing lymph nodes in the neck of patients with thyroid cancer may help prevent the disease from recurring, according to a new study (Surgery, December 2011, Vol. 150:6, pp. 1048-1057).
Although it is standard procedure in some cancer centers, there has been debate in the surgical community about the benefits of routinely removing neck lymph nodes in patients with thyroid cancer, a procedure known as prophylactic central neck lymph-node dissection (CLND).
But in the Surgery study, an international research team found that routine removal of neck lymph nodes during initial thyroid surgery for papillary cancer may lead to lower disease recurrence rates and lower levels of thyroglobulin, a thyroid tumor marker that can be an indicator of disease when elevated.
The researchers examined data on 606 patients who received care in one of three endocrine surgical units: the University of California, Los Angeles (UCLA) Medical Center; the University of Sydney, Australia; and Hammersmith Hospital at Imperial College London. Patients were divided into two groups: Group A patients had undergone total thyroid removal alone; group B patients had undergone both thyroid removal and dissection of central neck lymph nodes. Patients were followed for an average of three-and-a-half years following surgery.
The rate of disease recurrence in the entire study population was 6.9%, the study authors reported. They found that the need for central neck reoperation was significantly lower among patients who had undergone the routine initial central neck lymph-node dissection, compared with those who had undergone only thyroid removal (1.5 % versus 6.1 %).
Stimulated thyroglobulin levels also were lower among patients in group B, which may demonstrate a more thorough clearing of disease in the patients who had both thyroid and neck lymph-node removal procedures, the researchers said.
The rate of long-term complications was low for both groups: about 1%.
A prospective, randomized clinical trial to further assess the impact of routinely removing central neck lymph nodes during initial surgery for papillary thyroid cancer would be a likely next step, according to the researchers.
