Published online Jul 28, 2015. doi: 10.5412/wjsp.v5.i2.177
Peer-review started: October 3, 2014
First decision: October 28, 2014
Revised: January 26, 2015
Accepted: March 18, 2015
Article in press: March 20, 2015
Published online: July 28, 2015
Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy, accounting for approximatley 90% of thyroid malignancies in areas of the world without deficit of Iodine. It’s universally accepted that total thyroidectomy is the minimal surgical treatment for patients with PTC higher than 1 cm. When a quality surgery is performed, the prognosis for PTC is excellent with 10 and 20-year overall survival rates around 90% and 85%, respectively. Lymph node metastases are very frequent in PTC, occurring in 50%-80% of PTC patients, the most of them being located in the central compartment of the neck (CCN) and with a high rate of occult or clinically undetectable disease. A lot of controversy exists regarding how to treat the central nodal compartment disease of PTC. The first problem is the lack of standardization of the terminology and concepts related to the CCN, which are clearly established and defined in this paper according to the most recent consensus documents of endocrine societies. This uniformity will provide a more consistent and clear communicaction between all the specialist involved in the treatment of PTC. CCN can be performed to treat patients with clinically detectable, radiologically suspected of intraoperative visualized nodal disease (this is defined as therapeutic) or when these findings are absent (also called prophylactic). Indicactions, advantages and disadvantages of both therapeutic and prophylactic CCN dissection are widely discussed and clear recommendations provided.
Core tip: When papillary thyroid cancer is discussed anywhere, there are two main matters of controversial which centralize the debates. The first one is the need of having an uniform standardization of the concepts related to the dissection of the central compartment: limits and terminology. The second point is about the concept of prophylactic dissection of the central compartment if patients with neither clinical nor radiological nodal disease related to papillary thryroid carcinoma. Both of the points are clearly defined in this paper and the readers will have clear ideas about what to when facing a papillary thyroid carcinoma.