Surgical management of papillary thyroid carcinoma


  • Wael M. Elgamal Department of Surgery, Damanhour Oncology Centre, Damanhour, Egypt
  • Ragheb A. Ragheb Department of General Surgery, Faculty of Medicine for Girls, Azhar University, Cairo, Egypt
  • Ashraf Elsharkawy Department of General Surgery, Faculty of Medicine for Girls, Azhar University, Cairo, Egypt



Papillary thyroid carcinoma, Thyroidectomy, Prophylactic neck dissection


Background: Papillary thyroid carcinoma (PTC) is the most prevailing thyroid cancer but remains of a favorable prognosis. Thyroidectomy with excision of all positive cervical nodes remains the cornerstone of the management PTC. The role for prophylactic central neck dissection (PCND) remains controversial. 

Methods: A prospective non randomised open label study of 20 PTC patients, 8 of them underwent total thyroidectomy with PCND and 12 underwent total thyroidectomy with modified radical neck dissection type III in El Zahraa hospital, Azhar university, and Damanhour oncology center, Egypt starting from September 2019 to August 2021. The incidence of central lymph node metastasis in N0 cases underwent PCND were reported, the relationship between lymph node metastasis with lympho-vascular permeation and capsular invasion, were analysed and sensitivity of fine needle aspiration cytology in diagnosis of PTC was reported.

Results: Occult central lymph node metastasis was observed in 62.5% of PTC lesions. The FNAC showed a sensitivity of 85%. Lympho-vascular permeation and capsular invasion showed a sensitivity of 94.12% and 58.82%, respectively for lymph nodes metastasis. Thyroiditis is detected in 50% of cases with PTC. Postoperative ablative dose of radioactive iodine 131 (RAI-131) ranged from 80 to 100 millicurie.

Conclusions: R0 resection is mandatory to cure PTC. PCND remains a debatable issue, that needs a large multicentre study with large sample of patients with long term follow up to ascertain the efficacy of PCND in reducing rate of local recurrence, morbidity and mortality.

Author Biography

Wael M. Elgamal, Department of Surgery, Damanhour Oncology Centre, Damanhour, Egypt



Spinelli C, Strambi S, Bakkar S, Nosiglia A, Elia GM, Bertocchini A et al. Surgical Management of Diffuse Sclerosing Variant of Papillary Thyroid Carcinoma. Experience in 25 Patients. World J Surg. 2019;44(1):155-62.

Uchino S, Ishikawa H, Miyauchi A, Hirokawa M, Noguchi S, Ushiama M et al. Age- and Gender-Specific Risk of Thyroid Cancer in Patients with Familial Adenomatous Polyposis. J Clin Endocrinol Metab. 2016;101(12):4611-7.

Ito Y, Miyauchi A, Kihara M, Fukushima M, Higashiyama T, Miya A. Overall Survival of Papillary Thyroid Carcinoma Patients:A Single-Institution Long-Term Follow-Up of 5897 Patients. World J Surg. 2018;42:615-22.

National comprehensive cancer network (NCCN) guidelines version 2, 2021. Thyroid carcinoma- papillary carcinoma. Available at: https://www.nccn. org/professionals/physcian_gls/pdf/thyroid.pdf. Accessed on 05 March 2021.

Conzo G, Tartaglia E, Avenia N, Calò PG, De Bellis A, Esposito K et al. Role of prophylactic central compartment lymph node dissection in clinically N0differentiated thyroid cancer patients: analysis of risk factors and review of modern trends. World J Surg Oncol. 2016;14:149.

Attard A, Paladino NC, Lo Monte AI, Falco N, Melfa G, Rotolo G et al. Skip metastases to lateral cervical lymph nodes in differentiated thyroid cancer: a systematic review. BMC Surg. 2019;18(1):112.

Haugen BR, Alexander EK, Bible KC, Doherty GM. American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133.

Lorenz K, Schneider R, Elwerr M. Thyroid Carcinoma: Do We Need to Treat Men and Women Differently. Visc Med. 2020;36:10-3.

Brito JP, Yarur AJ, Prokop LJ, McIver B, Murad MH, Montori VM. Prevalence of Thyroid Cancer in Multinodular Goiter versus Single Nodule: A Systematic Review and Meta-Analysis. THYROID. 2013;23(4):449-55.

Li G, Lei J, You J, Jiang K, Li Z. Independent predictors and lymph node metastasis characteristics of multifocal papillary thyroid cancer. Medicine. 2018;97:5(e9619).

Hajmanoochehri F, Rabiee E. FNAC accuracy in diagnosis of thyroid neoplasms considering all diagnostic categories of the Bethesda reporting system: A single-institute experience. J Cytol. 2015;32(4):238-43.

Lai X, Xia Y, Zhang B, Li J, Jiang Y. A meta-analysis of Hashimoto’s thyroiditis and papillary thyroid carcinoma risk. Oncotarget. 2017;8(37):62414-24.

Albuja-Cruz MB, Thorson CM, Allan BJ, Lew JI, Rodgers SE. Number of lymph nodes removed during modified radical neck dissection for papillary thyroid cancer does not influence lateral neck recurrence. Surgery. 2012;152:1177-83.

Atakan A, Celik M, Bulbul BY, Can N, Tastekin E, Ayturk S et al. Relationship between lymphovascular invasion and clinicopathological features of papillary thyroid carcinoma. Bosn J Basic Med Sci. 2017;17(2):144-51.

Mao J, Zhang Q, Zhang H, Zheng K, Wang R, Wang G. Risk Factors for Lymph Node Metastasis in Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis. Frontiers in Endocrinol. 2020;11:265.

Sun W, Lan X, Zhang H, Dong W, Wang Z, He L et al. Risk Factors for Central Lymph Node Metastasis in CN0 Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis. PLoS ONE. 2015;10:e0139021.

Lie-Hao J, Chen C, Tan Z. Clinical Characteristics Related to Central Lymph Node Metastasis in cN0 Papillary Thyroid Carcinoma: A Retrospective Study of 916 Patients. Int J Endocrinol. 2014;385787:6.

Andresen NS, Buatti JM, Tewfik HH, Pagedar NA, Anderson CM, Watkins JM. Radioiodine Ablation following Thyroidectomy for Differentiated Thyroid Cancer: Literature Review of Utility, Dose, and Toxicity. Eur Thyroid J. 2017;6:187-96.






Original Research Articles