Disección ganglionar electiva en cáncer bien diferenciado de tiroides

Introduction. Central-level lymph nodes refers to nodes located around the thyroid gland, specifically in the paratracheal region, below the hyoid bone, and in the superior mediastinum. In patients with thyroid cancer who show no preoperative evidence of metastasis, elective dissection of these nodes is a subject of controversy; it is associated with higher complication rates and is not always beneficial, necessitating careful selection of candidates for the procedure. The aim of this study was to identify patients at higher risk of central-level lymph node metastasis, based on tumor characteristics, who would be candidates for dissection of this level. Methods. A retrospective, cross-sectional, observational, and analytical study of patients with well-differentiated thyroid cancer treated with total thyroidectomy and central neck dissection. Gender, age, tumor size, glandular capsular rupture, perithyroidal tumor invasion, and the number of dissected lymph nodes were evaluated and compared with the presence of lymph node metastases. Results. Eighty-five patients were included, with a mean age of 49 years. Factors associated with lymph node metastases were tumor size, the dissection of six or more lymph nodes, and capsular rupture with infiltration of perithyroidal tissues (pT3). Conclusions. Factors that most reliably predict central lymph node status are perithyroidal tumor invasion (pT3), the dissection of six or more lymph nodes, and a tumor size of 4 cm or greater. Elective central compartment dissection should be performed in patients presenting with these characteristics.