The Role of Prophylactic Central Neck Dissection in Differentiated Thyroid Carcinoma: Issues and Controversies

Table 1

A summary of the arguments for and against prophylactic neck dissection (pCND) during total thyroidectomy for differentiated thyroid carcinoma.

Arguments for pCND	Arguments against pCND
Subclinical central lymph node metastasis is common	Only a small proportion of subclinical central lymph node metastasis would develop clinically significant recurrences
Lymph node metastasis leads to higher recurrences and poorer survival	There is no level-one evidence to suggest that pCND could improve survival
pCND may reduce recurrence and lower postoperative thyroglobulin levels	Tumor upstaging leads to more radio-iodine ablation which might not be necessary
Preoperative and intraoperative evaluations of central compartment lymph node metastasis are not reliable	Operation in recurrent case could be safely performed by experience hands
Improved tumor staging and stratification of tumors	Majority of thyroidectomy are performed by low-volume surgeons
Reduce the need for reoperation in central neck recurrence which is associated with greater morbidity	Increased surgical morbidities (hypoparathyroidism and recurrent laryngeal nerve injury)
pCND can be safely performed with comparable morbidity to thyroidectomy alone in experience hands