Prophylactic "First-Step" Central Neck Dissection (Level 6) Does Not Increase Morbidity After (Total) Thyroidectomy: A Reply

See original letter here.

Letter to the Editor

By Andreas Selberherr, MD, Philipp Riss, MD, Christian Scheuba, MD, and Bruno Niederle, MD
From the Medical University, Vienna, Austria, Währinger Gürtel 18-20; A-1090 Vienna, Austria

To the Editors:

Thank you for the reply to our article [1] by I.J. Nixon. Some of his critical comments have to be clarified.

This is a single-center technical report demonstrating the possible advantage of “first step” (FS) and therefore prophylactic unilateral and bilateral central neck dissection (CND) if indicated.

As stated by Carty et al [] in the consensus statement on the terminology and classification of CND for thyroid cancer, we defined the boundaries of the central neck superiorly by the hyoid bone, laterally by the carotid arteries, anteriorly by the superficial layer of the deep cervical fascia, and posteriorly by the deep layer of the deep cervical fascia.  Also, the lymphatic tissue of the anterior superior mediastinum, which is accessible by a cervical approach, was removed by the described approach.

The controversies regarding whether to perform or not to perform prophylactic CND to improve survival or to prevent local recurrence [3] were not discussed in the article.

Concerning the effect of prophylactic CND on locoregional recurrence rates the meta-analysis by Wang et al [4] revealed no difference in recurrence or long-term complication rates between patients undergoing total thyroidectomy alone or total thyroidectomy with (prophylactic) CND. In accordance with our study, [1] Wang et al conclude on the basis of their meta-analysis, that routine prophylactic CND might be considered in the hands of high-volume surgeons treating patients with clinically node-negative PTC.


1. Selberherr A, Riss P, Scheuba C, Niederle B. Prophylactic "first-step" central neck dissection (level 6) does not increase morbidity after (total) thyroidectomy. Ann Surg Oncol. 2016;23(12):4016-4022.

2. Carty SE, Cooper DS, Doherty GM, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid. 2009;19(11):1153- 1158.

3. Clayman GL, Agarwal G, Edeiken BS, Waguespack SG, Roberts DB, Sherman SI. Long-term outcome of comprehensive central compartment dissection in patients with recurrent/persistent papillary thyroid carcinoma. Thyroid. 2011;21(12):1309-1316.

4. Wang TS, Cheung K, Farrokhyar F, Roman SA, Sosa JA. A meta-analysis of the effect of prophylactic central compartment neck dissection on locoregional recurrence rates in patients with papillary thyroid cancer. Ann Surg Oncol. 2013;20(11):3477-3483.

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