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Analysis of our patients who did not receive postoperative radiotherapy revealed that they had a greater than 20% risk of neoplastic recurrence in the neck when the central compartment lymph nodes were not removed (because the LCSE was not appreciated prior to definitive surgery) and thyroid gland lobectomy was not performed with TLND.
Fewer than 40 cases of LCSE following TLND have been reported in the literature.
In conclusion, our findings suggest that adjuvant postoperative radiotherapy is not ill advised in pN0 LCSE patients when (1) the thyroid gland lobe has not been removed during TLND, (2) the level VI node is not assessed for disease status because the LCSE is not apparent prior to or during TLND, and (3) additional adverse histopathology is observed.