Recurrence and surveillance intensity after prophylactic central neck dissection for papillary thyroid carcinoma: Long-term follow-up of a randomized trial
In brief
Preventive neck dissection raised thyroid cancer surveillance by 21%, with no observed reoperations
In a randomized trial of 57 patients followed for a median of 6.4 years, neither group had a recurrence requiring reintervention; Bayesian estimates suggested low recurrence risk with or without preventive central neck dissection. The added procedure was linked to 21% more surveillance, without meaningfully reducing recurrence or follow-up needs, though the small trial leaves uncertainty about long-term risk.
- Journal
- Surgery (Q1)
- Published
- 2 September 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Caitlin B Finn, Benjamin A Y Cher, Nicholas M Druar, Alexandra Helbing, Travis Cotton, Megan K Applewhite, et al.
- PMID
- 42971900
- DOI
- 10.1016/j.surg.2026.110598
Why clinicians should know about it
- Picked for Breast and Endocrine Surgery (paper of the day, 3 November 2026): Randomized follow-up informs extent of thyroid cancer neck surgery
- Picked for Surgical Oncology (paper of the day, 3 November 2026): Randomized trial of prophylactic central neck dissection
Abstract
BACKGROUND: There is ongoing debate about whether prophylactic central neck dissection in addition to total thyroidectomy reduces recurrence for patients with clinically node-negative papillary thyroid carcinoma. We present long-term follow-up of a randomized trial comparing total thyroidectomy with prophylactic central neck dissection to total thyroidectomy alone. METHODS: Patients with clinically node-negative papillary thyroid carcinoma were randomized to total thyroidectomy alone or total thyroidectomy with prophylactic central neck dissection and followed for a median of 6.4 years. The primary outcome was reintervention for recurrence. The secondary outcome was surveillance intensity: the frequency of biopsies, imaging studies, and clinic visits. We used Bayesian analysis to synthesize results with the existing evidence. RESULTS: Among 57 patients, 29 were randomized to total thyroidectomy alone and 28 to total thyroidectomy with prophylactic central neck dissection. During follow-up, we observed no recurrences requiring reintervention in either group. In Bayesian analysis, the predicted long-term recurrence risk for total thyroidectomy patients was 3.4% (95% credible interval, 1.2%-9.9%) and 0.4% (95% credible interval, 0.1%-6.2%) when adding prophylactic central neck dissection. During surveillance, total thyroidectomy patients underwent a median (interquartile range) of 1.3 (1.2-1.5) clinic visits and 0.8 (0.7-0.9) ultrasounds per year, compared with 1.5 (1.2-2.0) visits and 0.9 (0.7-1.1) ultrasounds for total thyroidectomy with prophylactic central neck dissection patients. Patients in the total thyroidectomy group underwent a median (interquartile range) of 2.1 (1.9-2.5) follow-up encounters per year, compared with 2.4 (2.1-2.9) among patients who underwent total thyroidectomy with prophylactic central neck dissection (P = .21). Overall, prophylactic central neck dissection led to a 21% relative increase (95% credible interval, 1%-43%) in surveillance intensity. CONCLUSION: For patients with clinically node-negative papillary thyroid carcinoma, prophylactic central neck dissection is unlikely to meaningfully reduce recurrence or requirements for postoperative surveillance compared with total thyroidectomy alone.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.