الفهرس 
AcknowledgementsOnly 14 pages are availabe for public view
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Abstract
Low risk of transient or permenant hypocalcemia (transient or permenant) observed in our study also decrease risk of recurrent laryngeal nerve injury. This fact was also noticed in recent large metanalysis Ji, Song et al. (196) So, Son et al.(196), Ji, Song et al.(197) recommend performing central neck dissection in the same time of performing thyroidectomy as PTC has high incidence of cervical lymph node metastases that was in line with our study rationale. But many previous researchers found a contradictory results regarding central neck dissection that it did not decrease rates of tumor recurrence, did not improve patients survival in addition to more risks of causing post-operative complications as vocal cord palsy and hypo- parathyroidism.(176, 196, 198) The contradictory results were found in studies as Zhao, You et al.(176), Yoo, Song et al.(199) and Kim, Woo et al.(200) which showed that central neck dissection has no advantage regarding decreasing recurrence of the disease or improving patients out come in comparison to thyroidectomy alone. Zhao, You et al.(176) suggested that although pCND reduced the LRR in PTC—specifically in the central neck compartment—it was accompanied by an increased rate of postoperative hypocalcemia. Yoo, Song et al.(199) showed that the efficacy of prophylactic CND might be limited in PTC. Therefore, pCND might not be recommended for PTC, especially for PTC < 4 cm and no major ETE. Kim, Woo et al.(200) suggest that CND be reserved for therapeutic situations as Patients who underwent pCND showed significantly higher incidences of temporary vocal cord palsy and temporary/permanent hypoparathyroidism so pCND may not be recommended as a routine procedure even in PTC patients with aggressive features, including large tumor size, multifocality, or ETE. This study has limitations, first it was nonrandomized retrospective cohort study, and second, there were possible surgeon bias both in decisions regarding pCND and performance of pCND. Third, although RAI therapy was generally proposed for patients classified as high risk for recurrence (e.g., old age, large tumor size, ETE, LN metastasis, and individual histology), the final decision was made according to physician or patient preference.
Long term follow-up of patients for recurrence and survival rates which were lacked in other reports. Prospective nature of the study. Lack of randomized and comparative nature. Small sample size (20 patients). Most studied tumors were less than 3 cm in size so it was difficult to determine benefits of central neck dissection in tumors sized more than 4 cm. Further studies that included with larger number of PTC patients and included larger tumors are needed to overcome these limitations and determine differences in recurrences between included groups. Thyroid carcinoma is the most common endocrine malignancy. It has been dramatically increased almost worldwide, over the last four decades. The indolent nature of differentiated thyroid carcinoma imposes a redirection of the standard of care from increase of survival rate, exceeding 95% at 5 years. Papillary thyroid carcinoma is an epithelial malignancy showing evidence of follicular cell differentiation and a set of distinctive nuclear features. It is the most frequent thyroid neoplasm and carries the best overall prognosis. Approximately one third of patients with papillary thyroid cancers have detectable involved nodes at the time of presentation. The other two thirds that do not have obvious involved lymph nodes on the basis of clinical examination and scanning, it is suggested that up to 80 % of them will have metastases in dissected nodes. The role of total thyroidectomy remains well-established as the standard treatment of papillary thyroid carcinoma, while recently, a new substantial agreement exists among endocrinologists regarding thyroid stimulating hormone suppression therapy and postoperative radioactive iodine treatment. While there is consensus that therapeutic central neck dissection should be performed in the presence of clinical lymph node metastases in the central compartment, prophylactic central neck dissection in clinically node-negative patients remains controversial. The 2015 American Thyroid Association guidelines in recommendation 36 stated that ‘‘prophylactic CND (ipsilateral or bilateral) should be considered in patients with papillary thyroid carcinoma with clinically uninvolved central neck lymph nodes who have advanced primary tumors or clinically involved lateral neck nodes, or if the information will be used to plan further steps in therapy. In our prospective cohort study, we selected twenty patients with papillary thyroid carcinoma with absence of suspicious enlarged cervical lymph node clinically or with ultra-sonographic assessment between July 2019 and July 2020.These patients underwent total thyroidectomy with bilateral central neck dissection. We selected patients with papillary thyroid cancer diagnosed with fine needle aspiration cytology and clinically and ultrasonographic negative cervical lymph nodes. We excluded Patients with clinical evidence of cervical lymph node or with neck ultrasound, or patients with distant metastases. We also excluded patients with a previous history of thyroidectomy or with mixed-type papillary thyroid cancer. All the patients included in the study had undergone a preoperative physical examination, high- resolution neck ultrasound, fine needle aspiration cytology of suspicious nodules, and measurement of serum thyroid hormones, and preoperative fibro-laryngoscopy was also routinely performed. Histopathological examination of thyroid specimen was done and lymph nodes harvested from each patient were accurately examined. One year-postoperative follow up was done to all cases including serum calcium levels were assayed on the first and second postoperative day, and then on the basis of the evolution of clinical and biochemical parameters, fibro-laryngoscopy was performed to assess vocal cord mobility, and serum Tg and Tg-antibody levels were assayed every 6 months together with neck ultrasound. According to our results we found that classic variant of papillary thyroid carcinoma (85%) was more than its follicular variant (15%) of all enrolled patients. Our results showed that (60%) of all enrolled patients had central lymph nodes metastasis while (40%) of enrolled patients has negative central lymph node involvement. We found that Post-operatively (90%) of all enrolled patients received radioactive iodine ablation. Regarding 12-month post-operative complications our study results showed (20%) of patients developed transient hypoparathyroidism, (15%) of patients developed transient vocal cord palsy, and none of all enrolled patients developed permanent hypoparathyroidism or permanent vocal cord palsy. Based on the aforementioned findings. we support performing central neck dissection in PTC with clinically and radiologically negative lymph nodes has a major role in decreasing recurrence rate and doesn’t increase postoperative morbidity as incidence of hypoparathyroidism or recurrent laryngeal nerve palsy, especially in specialized endocrine surgery centers.