• Iain J Nixon, Ian Ganly, Snehal G Patel, Luc G Morris, Frank L Palmer, Dorothy Thomas, R Michael Tuttle, Jatin P Shah, and Ashok R Shaha.
• Head and Neck Service, Memorial Sloan-Kettering Cancer Center, New York, NY.
• Surgery. 2013 Dec 1;154(6):1166-72; discussion 1172-3.

BackgroundThe role of prophylactic central neck dissection in the management of papillary thyroid cancer (PTC) is controversial. We report our experience of an observational approach to the cN0 neck in PTC.MethodsWe reviewed 1,129 patients with PTC who had total thyroidectomy between 1986 and 2005. In that group, 470 patients were pN1; 384 had benign nodes removed (pN0); and the remaining 275 had no nodes removed (pNx). The pNx group formed the cohort for this study.ResultsWith a median follow-up of 70 months, the 10-yr disease-specific survival was 100%. We found 4 patients who had evidence of radioactive iodine uptake on scans performed during follow-up without diagnostic cytology. All subsequently received radioactive iodine and are considered disease free. Three patients had biopsy-proven lateral-neck recurrence and underwent neck dissection; 1 patient developed a low-level thyroglobulin suspicious for recurrence; and 1 patient had a subcentimeter level VI node suspicious for recurrence, which has been observed. Therefore, the rate of structural recurrence in the central neck was 0.4% (1/275), and the rate of reoperation on the central neck was 0.ConclusionOur results suggest that properly selected patients can be managed safely with observation of the central neck rather than prophylactic central neck dissection, which has a higher complication rate.Copyright © 2013 Mosby, Inc. All rights reserved.

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