Does prophylactic central neck dissection improve outcomes in cN0 papillary thyroid carcinoma? A retrospective cohort study

This study aimed to assess the effect of ipsilateral prophylactic central neck dissection (pCND) on pathological nodal classification, radioiodine (RAI) utilization, response to therapy, and surgical morbidity in patients with cN0 PTC. This retrospective study included 718 patients with cN0 PTC who underwent total thyroidectomy (TTx) at the Istanbul Faculty of Medicine. Patients who underwent TTx plus pCND were classified as Group 1( n = 274), whereas those who underwent TTx alone were classified as Group 2( n = 444). Demographic characteristics, histopathological features, RAI utilization, morbidity, response to therapy, and locoregional recurrence were compared between groups. The demographic characteristics were similar between the groups. Although tumor size did not differ significantly, Group 1 had higher rates of aggressive histopathological features, including perineural invasion, multicentricity, and intrathyroidal spread (all p < 0.05). The median central lymph node yield in Group 1 was 6 (IQR, 4–9), and central lymph node metastasis was detected in 28.8% of the patients. RAI administration was more frequent in Group 1 than in Group 2 (74.8% vs. 58.3%, p = 0.001). Temporary hypoparathyroidism was more frequent in Group 1 (30% vs. 22%, p = 0.01), whereas the rates of permanent hypoparathyroidism and recurrent laryngeal nerve injury were similar. Among patients with T1–T2 tumors without vascular invasion, nodal status reclassification from cN0 to pN1a following the detection of occult lymph node metastasis was more frequent in Group 1 than in Group 2(23.7% vs. 1.4%, p < 0.001). pCND was associated with a higher likelihood of nodal status reclassification. The excellent response and locoregional recurrence rates were comparable between the groups. pCND provided additional pathological nodal information by detecting occult lymph node metastasis and was associated with increased postoperative RAI administration. However, no statistically significant differences in response to therapy or locoregional recurrence were observed between the groups, and the low number of recurrence events limited definitive conclusions regarding the oncologic benefit. These findings support the selective, risk-adapted, rather than routine, use of pCND.