Even if cervical lymph node micro-metastases are observed in up to 80% patients with papillary thyroid cancers (PTC), of whom postoperative survival are still good. Whether prophylactic central lymph node dissection (pCLD) should be performed in all patients with cN0 PTC remained controversial. However, pCLD could not only remove potential metastatic lesions, but also be helpful of postoperative staging. It could reduce the complications of re-operation, but might increase the risk of hypoparathyroidism of the first operation. Nevertheless, selective surgical options in high-risk cases is supported by recent clinical guidelines. Standardized dissection should be performed and complications should be avoided during pCLD. Prospective randomized trials are still needed to evaluate the benefits of different approaches for better clinical outcome.