Assessement of thymic metastasis in the differentiated thyroid cancer with positive central lymph nodes

Abstract

Background: Thyroid cancer, particularly differentiated thyroid carcinoma (DTC), is the most prevalent malignant endocrine tumor. Management of central compartment lymph nodes (CCLN) is crucial in the surgical treatment of DTC due to frequent nodal metastases. This study evaluates the benefits and risks of unilateral thymectomy (UT) versus thymus preservation (TP) during total thyroidectomy with central neck dissection (CND) in DTC patients with positive central lymph nodes. Materials and methods: A prospectiveobservationalstudy was conducted from January 2023 to December 2023, involving 117 patients with preoperatively diagnosed thyroid carcinoma and positive central lymph nodes. Patients were allocated to either the TP group (n=59) or the UT group (n=58). Outcomes measured included rates of hypoparathyroidism, thymic metastasis, and other surgical complications. Results: showed no thymic metastases in either group. However, UT group was associated with higher rates of transient hypoparathyroidism and vocal cord palsy compared to TP group. Permanent hypoparathyroidism was rare, and no significant differences were observed in other complications like bleeding and lymphatic leakage. Conclusions: routine thymectomy during CND in DTC patients does not provide additional oncological benefits and is associated with a higher risk of transient hypoparathyroidism. Therefore, preserving the thymus is recommended during CND even in patients with positive central lymph nodes. Further large-scale, long-term studies are necessary to substantiate these findings.