Evaluating the effectiveness of prophylactic central neck dissection with total thyroidectomy for cN0 papillary thyroid carcinoma: An update meta-analysis

Publication date: Available online 3 August 2017
Source:European Journal of Surgical Oncology (EJSO)
Author(s): Wan-jun Zhao, Luo Han, Yi-mei Zhou, Wen-yu Dai, Jing-qiang Zhu
BackgroundThe effectiveness of prophylactic central neck dissection (pCND) following total thyroidectomy (TT) in patients with clinical node-negative (cN0) papillary thyroid carcinoma (PTC) is still controversial. The aim of the meta-analysis is to evaluate the outcome of pCND and provide quantitative evidence.MethodA detailed literature search of PubMed, EMBASE, ClinicalTrails.gov and Cochrane Library electronic databases for articles published until October 2016 was carried out. This meta-analysis was performed by random method (Mantel-Heanszel) model. Locoregional recurrence (LRR) and surgical complications were analyzed.Results22 studies with comparison between pCND+TT (combined) and TT alone in cN0 PTC patients. A total of 6930 cases were enrolled, including 2381 cases in combined group and 4009 cases in the TT alone group. Compared with TT alone, patients in combined group showed significantly lower rate of overall LRR (OR=0.66, 95% Cl=0.48-0.89) and central compartment recurrence (OR=0.40, 95% Cl=0.22-0.73). There was no statistically difference in the rate of lateral compartment recurrence. However, combined group showed significantly higher rate of temporary, permanent hypoparathyroidism (OR=2.28, 95% Cl=1.92-2.27/OR=1.84, 95% Cl=1.15-2.95) and temporary recurrent laryngeal nerve injury (LNR) (OR=1.53,95% Cl=1.08-2.16). There was no statistical difference in the rate of permanent LNR, hematoma, hemorrhage and wound infection.ConclusionsThis meta-analysis revealed that pCND with TT was significantly efficient to reduce the risk of LRR. However, pCND+TT increase the incidence rate of temporary and permanent hypoparathyroidism and temporary LNR.



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