Cervical Lymphadenectomy in Papillary Thyroid Cancer

Papillary thyroid cancer (PTC) spreads preferentially to lymph nodes. When central or lateral cervical lymph node basins are macroscopically affected by PTC, compartmental clearance is the treatment of choice since this increases disease-free and arguably overall survival. The role of prophylactic central (pCND) and lateral node dissection (pLND) in the absence of macroscopic disease remains more contentious. A pCND at the index thyroidectomy may reduce the rate of locoregional recurrence and yield additional staging information that may direct adjuvant treatment. However, pCND is associated with morbidity, in particular hypoparathyroidism that probably exceeds any benefit that it may provide. This chapter reviews the current evidence for nodal dissection in differentiated thyroid cancer.