During total thyroidectomy for a 3 cm papillary thyroid carcinoma, the surgeon performs prophylactic central compartment neck dissection (level VI) despite clinically negative nodes. Which statement best describes the evidence for this practice?

• A It improves overall survival in node-negative differentiated thyroid cancer
• B It is routinely recommended for all papillary thyroid carcinomas greater than 1 cm
• C It reduces locoregional recurrence but does not improve overall survival ✓
• D It significantly increases the risk of permanent hypoparathyroidism compared to no dissection but not recurrent laryngeal nerve injury

Explanation

Prophylactic central neck dissection reduces locoregional recurrence rates but has not demonstrated a survival benefit in clinically node-negative differentiated thyroid cancer. It is not routinely recommended for all tumors greater than 1 cm but may be considered for advanced primary tumors. It does increase the risk of temporary hypocalcemia, though permanent hypoparathyroidism rates are similar to total thyroidectomy alone in experienced hands.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.