Central Compartment Neck Dissection With Thyroidectomy

NCT ID: NCT01106443

Last Updated: 2016-12-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

TERMINATED

Clinical Phase

NA

Total Enrollment

128 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-02-28

Study Completion Date

2016-10-31

Brief Summary

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When a patient presents with a thyroid mass, part of the work-up may include a fine needle aspiration biopsy (FNAB). The results of the biopsy then help plan treatment. If the results are benign, the management will typically be to follow the nodule. If the results demonstrate or are suspicious for cancer, such as papillary thyroid carcinoma (PTC), the treatment is a total thyroidectomy (total thyroid removal). The latest American thyroid association guidelines for PTC (2009) suggest that in many instances a central lymph node dissection (CLND) should be performed in conjunction with the total thyroidectomy. This procedure consists of removing the lymphatic (glandular) tissues surrounding the thyroid itself, as this tissue may have a propensity for cancer spread. The procedure's necessity has met much controversy in the last decade, but is becoming more of a standard in thyroid cancer surgery.

When a thyroid nodule FNAB is reported as indeterminate, the treatment strategy is less clear cut. While a diagnostic hemi-thyroidectomy or therapeutic total thyroidectomy may be in order, the inclusion of CLND is not clearly defined. In many centers a CLND will be omitted with surgical management for an "indeterminate" lesion, while in others, it is standard protocol. The argument of performing CLND is largely based on the tenet that it adds little surgical time, cost or risks to the patient. Because the evidence of the prognostic role of lymph node metastases is limited many would argue that the risk of not performing CLND is greater than performing CLND. Furthermore, in the event of finding cancer on final pathology, and thus, having to re-operate in the thyroid/central compartment bed, post-operative complications may increase. Opponents of CLND argue that there is a paucity of strong evidence supporting CLND in the improvement of oncologic outcomes and can potentially increase post-operative low calcium levels or vocal nerve damage However, these recommendations are based on retrospective level III evidence. Thus the debate continues: is CLND justified as an adjunct to hemi-or total thyroidectomy in indeterminate thyroid pathology?

The hypothesis is: CLND in hem- or total thyroidectomy for "indeterminate" thyroid nodules will not increase post-operative complications.

Detailed Description

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Conditions

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Indeterminate Thyroid Nodules

Keywords

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Indeterminate thyroid nodule fine needle aspirate biopsy thyroidectomy central lymph node dissection

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

DOUBLE

Participants Investigators

Study Groups

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Total Thyroidectomy - CLND

Total thyroidectomy without central lymph node dissection.

Group Type ACTIVE_COMPARATOR

Total thyroidectomy - CLND

Intervention Type PROCEDURE

Removal of all possible thyroid tissue without dissection of neck level 6.

Total Thyroidectomy +CLND

Total thyroidectomy with central lymph node dissection.

Group Type EXPERIMENTAL

Total Thyroidectomy + CLND

Intervention Type PROCEDURE

Total thyroidectomy includes removing all possible thyroid tissue. Central lymph node dissection is a neck level 6 dissection. This includes removal of all central lymphatics from carotid artery to carotid artery and hyoid to sternum/clavicle.

Hemi-thyroidectomy + CLND

Hemi-thyroidectomy with central lymph node dissection.

Group Type EXPERIMENTAL

Hemi-thyroidectomy + CLND

Intervention Type PROCEDURE

Removal of one thyroid lobe and ipsilateral central lymph nodes

Hemi-thyroidectomy - CLND

Hemi-thyroidectomy without central lymph node dissection.

Group Type ACTIVE_COMPARATOR

Hemi-thyroidectomy - CLND

Intervention Type PROCEDURE

Removal of one thyroid lobe only. No lymphatic dissection.

Interventions

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Total Thyroidectomy + CLND

Total thyroidectomy includes removing all possible thyroid tissue. Central lymph node dissection is a neck level 6 dissection. This includes removal of all central lymphatics from carotid artery to carotid artery and hyoid to sternum/clavicle.

Intervention Type PROCEDURE

Total thyroidectomy - CLND

Removal of all possible thyroid tissue without dissection of neck level 6.

Intervention Type PROCEDURE

Hemi-thyroidectomy + CLND

Removal of one thyroid lobe and ipsilateral central lymph nodes

Intervention Type PROCEDURE

Hemi-thyroidectomy - CLND

Removal of one thyroid lobe only. No lymphatic dissection.

Intervention Type PROCEDURE

Eligibility Criteria

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Inclusion Criteria

* Indeterminate or benign pathology on fine needle aspirate biopsy
* Scheduled to undergo total or hemi-thyroidectomy
* \> 18 years old

Exclusion Criteria

* Previous thyroid surgery
* Previous neck surgery in field of thyroidectomy
* Previous neck irradiation
* Pre-operative hypocalcemia or hypoparathyroidism
* Biopsy suggestive of thyroid cancer
* Neck nodes suspicious for or with known cancer
* Pre-operative vocal cord dysfunction
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University of Alberta

OTHER

Sponsor Role lead

Responsible Party

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Peter Dziegielewski

MD, FRCSC

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Peter T Dziegielewski, MD

Role: STUDY_DIRECTOR

University of Alberta

Jeffrey R Harris, MD, FRCSC

Role: PRINCIPAL_INVESTIGATOR

University of Alberta

Robert Hart, MD, FRCSC

Role: STUDY_CHAIR

Dalhousie University

Elaine Fung, MD

Role: STUDY_CHAIR

Dalhousie University

Locations

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University of Alberta

Edmonton, Alberta, Canada

Site Status

Dalhouise University

Halifax, Nova Scotia, Canada

Site Status

Countries

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Canada

Other Identifiers

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88888

Identifier Type: -

Identifier Source: org_study_id