Parathyroid cancer is a disease primarily diagnosed and treated through surgical interventions. However, given the rarity of this disease, there is a lack of robust evidence to guide the optimal management and extent of initial resection, specifically related to the need for a central neck dissection. This chapter attempts to synthesize the available retrospective data to assess the association of central lymph node dissection with recurrence, survival, and complications in parathyroid cancer. Lymph node involvement, while relatively uncommon, acts as a marker for future recurrence. However, most locoregional recurrence occurs outside of the lymph nodes. Thus, central node dissection may impact disease-free survival time and possibly the need for further operations but is not associated with improved overall survival. Complication rates also appear similar between cases where central neck dissection was performed initially compared with those performed in the context of a reoperation. Further investigation into variables such as high impact CDC73 genetic mutations may help identify patients who would benefit most from more extensive resections.