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To date, in patients with differentiated thyroid cancer, central neck dissection is recommended in the presence of central compartment lymph node metastases. Differently, the efficacy of prophylactic central neck dissection in case of clinically node-negative differentiated thyroid carcinoma remains still uncertain. There are many arguments in favor and many against the execution of this surgical procedure. The most recent literature and latest guidelines have been reviewed and illustrated, paying particular attention to currently hottest and most discussed points. Prophylactic central neck dissection is associated with higher rates of postoperative complications, such as recurrent laryngeal nerve injury and hypoparathyroidism, with unclear oncological benefits. Thus, in the absence of lymph node involvement, this procedure should be avoided, reserving it for high-risk patients with advanced primary tumors. Moreover, to avoid serious complications, prophylactic central neck dissection should be performed by high-volume surgeons.