Central Neck Recurrence after Unilateral versus Bilateral Level 6 Dissection in Patients with Papillary Thyroid Carcinoma

Background:
Surgery for papillary thyroid cancer (PTC) often includes prophylactic or therapeutic lymph node dissection of the central neck compartment. Controversy exists regarding the extent of dissection, whether unilateral or bilateral, and its influence on disease recurrence rates.

Aim:
To assess disease recurrence rate in the central neck on the contralateral side among patients undergoing total thyroidectomy and central neck dissection.

Methods:
A retrospective study on patients diagnosed with PTC who underwent total thyroidectomy and central neck dissection between 2006-2021, and were followed in Rabin Medical Center, Israel. Patients were divided to two groups according to the type of surgery - unilateral or bilateral central neck dissection. The primary end point was the disease recurrence rate in central neck on the contralateral side.

Results:
We included 81 patients (69%female) with a mean age of 45 years (range 21-89). 27 patients (33%) underwent bilateral central neck dissection and 54 patients (67%) unilateral central neck dissection. The disease recurrence rate in the central neck was 0% and 3% for unilateral vs. bilateral central neck dissection. The disease recurrence rate in the lateral neck was 7% for both groups. Permanent vocal cord paralysis was seen in 2 patients (2.5%), both underwent bilateral central neck dissection. Hypoparathyroidism was seen in 2 vs. 5 patients among unilateral and bilateral central neck dissection, respectively.

Conclusions:
Our study demonstrates comparable disease recurrence rates for patients who underwent unilateral versus bilateral central neck dissection. Moreover, we found a higher complication rate among patients undergoing bilateral central neck dissection.