Outcomes of Prophylactic Central Neck Dissection in Clinically Node-Negative Papillary Thyroid Carcinoma: A Retrospective Study From a Tertiary Care Centre

Introduction Papillary thyroid carcinoma (PTC), the most common form of differentiated thyroid cancer, generally has an excellent prognosis. However, locoregional recurrence, particularly in cervical lymph nodes, remains a clinical concern. It is debatable whether preventive central neck dissection (PCND) is beneficial for patients with clinically node-negative (cN0) PTC because it may reduce recurrence but increase surgical complications. Objective The study aims to evaluate the role of PCND in patients with cN0 PTC by assessing the incidence of occult central lymph node metastases, postoperative complication rates, and long-term outcomes, including recurrence and survival. Methods A tertiary care facility carried out a retrospective investigation on 188 patients who had cervical lymph nodes that were clinically and radiologically negative between 2016 and 2023. Two groups of patients were formed: Group A (n=86) received total thyroidectomy (TT) alone, and Group B (n=102) underwent TT with PCND. Clinical, pathological, and postoperative data were collected and analyzed, with a follow-up duration of eight years. Results Recurrence rates have been similar in both groups, with central compartment recurrence being the most frequent. Adjuvant treatment, including radioactive iodine (RAI) therapy, was commonly administered. Overall and disease-free survival (DFS) rates have been comparable, and PCND did not significantly impact complication rates, including permanent hypoparathyroidism and vocal cord paralysis (p=0.609 and p=0.452). Importantly, individuals with KRAS and BRAF gene mutations demonstrated a higher probability of metastasis, suggesting the potential benefit of PCND for these high-risk cases. Conclusion PCND in cN0 PTC is associated with a low complication rate when performed by an experienced surgeon and may help reduce recurrence in high-risk patients with KRAS and BRAF gene mutations. However, recent guidelines recommend that T1 and T2 stage tumors shouldn't routinely undergo PCND unless there are additional high-risk features. Findings emphasize the need for a selective approach to PCND, guided by tumor characteristics and molecular markers.