Slovenská chirurgia 3/2012

Papillary thyroid cancer – controversy continues

Papillary thyroid cancer (PTC) is the most common of all thyroid cancers. There continues to be considerable debate in several aspects of management in patients with papillary thyroid cancer. Overall survival of the patients exceeds 90%, and 70–85% of patients are in low risk of recurrence and mortality. Total or near total thyroidectomy is mostly recommended and there is universal agreement that therapeutic nodal dissection should be performed in all patients with enlarged lymph nodes. However the use of prophylactic central lymph node dissection for clinically node-negative patients remains controversial due to the absence of clear evidence for a benefit in terms of better survival and an increased risk of complications of this procedure. As such, it’s more appropriate to perform prophylactic central lymph node dissection selectively only in patients in high risk of recurrence and mortality: larger tumors, extra-thyroidal extension or aggressive histologic subtypes. Physicians (endocrinologists and surgeons) must also have respect for patients’ autonomy and precisely inform them about mentioned above controversies and empower them to make decisions about their treatment.

Keywords: papillary thyroid cancer, thyroidectomy, lymphadenectomy.