Central neck compartment dissection in papillary thyroid carcinoma: An update

Table 1 Recommendations of the different international endocrine and thyroid societies about prophylactic central nodal compartment dissection

Scientific Thyroid Society	Year	Recommendations about prophylactic central neck compartment dissection
European Society of Endocrine Surgeons[36]	2014	Recommended in T3 or T4 tumors; age > 45-yr or < 15-yr; male sex; bilateral or multifocal tumors; and, evidence of involved lateral LN
British Thyroid Association[32]	2014	Central compartment neck dissection is not recommended for patients without clinical or radiological evidence of lymph node involvement. May be considered for patients: PTC non-classical type; > 45-yr; multifocal tumors; > 4 cm; and extra-thyroidal extension on US, but benefit is unclear
National Comprehensive Cancer Network (NCCN version 2.2014)[31]	2014	Consider prophylactic CNC dissection in patients with known distant metastases; bilateral nodularity; extrathyroidal extension; tumor > 4 cm; poorly differentiated histology (although the level of evidence is low, NCCN considers the intervention as appropriate)
Japanese Society of Thyroid Surgeons and Japan Association of Endocrine Surgeons[40]	2014	Previous 2010 JSTS/JAES guidelines recommended routine bilateral central node dissection in patients who underwent total thyroidectomy. At present guidelines, it is not routinely considered and the indication may depend on institutional policy and surgeons’ skill levels, joining ATA phylosophy
Société Française d’Oto Rhino Laryngologie et de Chirurgie de la Face et du Cou[34]	2012	In patients cN0, the diagnostic value of surgical exploration of the CNC is weak. Two different strategies are recommended: a compartment oriented CNC or not performing any surgical tecnique. Nonetheless, in patients with T3/T4 tumors prophylactic CNC dissection is strongly recommended
European Society of Medical Oncology Clinical Practice Guidelines[38]	2012	The benefit of prophylactic central node dissection in the absence of evidence of nodal disease is controversial. There is no evidence that it improves recurrence or mortality rate, but it permits an accurate staging of the disease that may guide subsequent treatment and follow-up
American Thyroid Association[33]	2009	Prophylactic central-compartment neck dissection (ipsilateral or bilateral) may be performed in patients with papillary thyroid carcinoma with clinically uninvolved central neck lymph nodes, especially for advanced primary tumors (T3 or T4)
German Association of Endocrine Surgeons[35]	2013	The clinical benefit regarding locoregional recurrence and survival after prophylactic compartment dissection for clinically node-negative PTC > 10 mm is unproven although occult lymph node metastases are common in this setting. To prevent the risk of surgical complications from outweighing a conceivable oncological benefit, prophylactic lymph node dissection is not advised unless the requisite surgical expertise is available

PTC: Papillary thyroid carcinoma; CNC: Central neck compartment; NCCN: National Comprehensive Cancer Network; ATA: American Thyroid Association; JSTS: Japanese Society of Thyroid Surgeons; JAES: Japanese Association of Endocrine Surgeons; LN: Lymph nodes.