**5. Conclusions**

The selection of patients for prophylactic CLND is problematic due to the low accuracy of preoperative and intraoperative evaluation in establishing what tumors are aggressive and could benefit from aggressive surgery. Prophylactic CLND is a safe procedure, with an acceptable incidence of complications, comparable to that of patients who undergo thyroidectomy alone. Our study demonstrated that pCNLD allows for more accurate staging of the tumor and reduces the incidence of recurrent disease in patients with intermediate and high risk DTC. We think that indications for pCNLD should be revised by the main guidelines, in consideration with the latest evidence in the literature.

**Author Contributions:** Conceptualization, F.M. and P.G.C.; Methodology, F.M., G.L.C., G.C. and E.E.; Formal analysis, F.M., G.A. and F.C.; Investigation, G.C., E.E. and P.G.C.; Data curation, G.L.C., G.A. and F.C.; Writing—original draft preparation, F.M. and G.L.C.; Writing—review and editing, G.C. and F.C.; Visualization, G.A.; Supervision, E.E. and P.G.C. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Conflicts of Interest:** The authors declare no conflict of interest.
