الفهرس 
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Abstract
There is no debate on central neck dissection (CND) and lateral neck dissection for clinically or radiologically positive lymph node (cN1) in papillary thyroid cancer (PTC) patients, while the need for prophylactic CND dissection in PTC patients with no evidence of macroscopic lymph node invasion (cN0) is still one of ongoing controversies.
In our study 40 patients with PTC at our surgery department and national cancer institute in the period from March 2013 to March 2015 were arranged into two groups, group 1include 20 patients with no evidence of macroscopic lymph node invasion (cN0) They underwent total thyroidectomy (TT) plus bilateral prophylactic CND dissection. group 2 include patients with ascertained or suspected cervical lymph node metastases They were treated with TT + bilateral therapeutic CND for all cases and LND in selected cases.
According to the short-term results of our study and the results from other studies tumor characteristics including extracapsular spread (ECS), multifocality and tumor size more than 1 cm were predictive factors for CLN metastases, so prophylactic CND is highly recommended in patients with these risk factors.
Incidence of occult metastases reached 40% of group 1 patients (prophylactic CND). Also contralateral central neck metastases in patients with unilateral tumor was high (20% in group 1and 50% group 2), so we recommend bilateral prophylactic CND.
Also There is no significant difference in the complication rate (RLN injury and hypoparathyroidism) between therapeutic and prophylactic modalities CND.
Finally we can conclude that CND can detect a remarkable number of cases with metastases in apparently healthy lymph nodes, thus increasing the probability of radical treatment and allowing more accurate staging of the disease. Therefore we believe that, when performed by an experienced thyroid surgeon, CND should be combined with TT in the primary treatment of PTC patients.
Limitations of our study is the short duration. Further studies with longer follow-up are needed to provide final conclusions about this important issue.