Background: Systematic elective paratracheal dissection for papillary thyroid carcinoma is controversial. Objective: This study aims to analyze the pattern of locoregional recurrence (LRR) to determine the potential benefit of elective paratracheal dissection and to identify prognostic factors influencing locoregional control and disease specific survival. Methods: A cohort of 342 patients who underwent a total thyroidectomy with or without neck dissection for a papillary thyroid carcinoma was retrospectively reviewed. Clinicopathological variables predicting for survival and control were examined. Results: All patients underwent total thyroidectomy and 84 underwent neck dissection as primary treatment. Sixty-six patients underwent a central compartment neck dissection. Twenty-eight (8.2%) patients developed LRR, of which 12 did not undergo neck dissection at initial surgery. The majority of neck recurrences were found in the lateral neck. Two patients (0.7%) without a paratracheal dissection done initially recurred only in the central compartment. On univariable analysis significant pathological predictors of locoregional control included tumor size, extrathyroidal extension (ETE), lymphovascular invasion and pathological lymph node status. Only ETE was a significant adverse prognostic variable for disease specific survival. On regression analysis, ETE and lymphovascular invasion were the only significant independent predictors of LRR. Paratracheal dissection did neither influence LRR nor central compartment control when adjusted for the effect of other variables. Background: Strong conclusions are difficult to draw without a comparable group, but these results suggest that the absolute benefit of elective paratracheal dissection is small.