Prophylactic central compartment dissection in thyroid cancer: A new avenue of debate

The December issue of Surgery traditionally publishes manuscripts presented at the Annual Meeting of the American Association of Endocrine Surgeons. This is one of the best sources of information for endocrine diseases, including nuances in the management of thyroid cancer. In recent years, there has been a paradigm shift in the management issues in thyroid cancer and new issues have been raised with technological advances in evaluating the extent of the disease, both pre-operatively and postoperatively. Our debate used to focus on extent of thyroidectomy in well-differentiated thyroid cancer, namely, total versus less than total thyroidectomy. The contemporary controversial issue mainly centers on the management of neck nodes, both central compartment (level VI) and lateral neck nodes. The American Thyroid Association (ATA) guidelines published in 2006 recommended that central compartment dissection should be considered for papillary carcinoma of the thyroid. Since these guidelines were published, there has been considerable debate in relation to the central compartment. Strong sentiments have been expressed by various authors. ^{,  ,  ,}  I do not think the ATA guidelines committee realized the controversy that would be generated by this statement. What was not appreciated was the risk group definition as an indication for evaluation and gross findings of the central compartment during surgery. The recent revised guidelines, which are expected to be published soon, revisit the issue of prophylactic central compartment dissection. The management of neck nodes and elective nodal dissection at level VI has generated several prospective studies and debates, primarily based on the philosophy of the individual surgeon rather than showing any major outcome advantages. There are 3 excellent papers addressing the issue of central compartment lymph nodes published in this issue of Surgery.