Prophylactic Central Neck Dissection for Papillary Thyroid Carcinoma with Clinically Uninvolved Central Neck Lymph Nodes: A Systematic Review and Meta-analysis

• Published in: World journal of surgery Vol. 42; no. 9; pp. 2846 - 2857
• Main Authors: Chen, Lawrence, Wu, Yi-Hsiu, Lee, Chia-Hwa, Chen, Hsin-An, Loh, El-Wui, Tam, Ka-Wai
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.09.2018; Springer Nature B.V
• Subjects: Abdominal Surgery; Carcinoma, Papillary - surgery; Cardiac Surgery; Confidence intervals; Decision Making; Dissection; Female; General Surgery; Humans; Hypocalcemia; Hypocalcemia - etiology; Injuries; Lymph nodes; Lymph Nodes - pathology; Lymphatic system; Male; Medicine; Medicine & Public Health; Meta-analysis; Neck; Neck Dissection - adverse effects; Odds Ratio; Original Scientific Report; Papillary thyroid carcinoma; Patients; Postoperative Complications; Recurrent Laryngeal Nerve Injuries - etiology; Surgery; Systematic review; Thoracic Surgery; Thyroid; Thyroid cancer; Thyroid Cancer, Papillary; Thyroid Neoplasms - surgery; Thyroidectomy; Thyroidectomy - adverse effects; Treatment Outcome; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-018-4547-4

Background Central neck dissection and total thyroidectomy are standard treatments for patients with papillary thyroid carcinoma (PTC) with clinically involved central nodes. However, prophylactic central neck dissection (pCND) in patients with clinically uninvolved cN0 has been beneficial in some studies but ineffective in others. We conducted a meta-analysis to evaluate the efficacy and safety of pCND in patients with central neck lymph nodes cN0 PTC. Methods The PubMed, EMBASE, Cochrane Library, and Scopus databases and the ClinicalTrials.gov registry were electronically searched for studies published until September 2017. The meta-analysis was conducted to calculate the pooled effect size by using random-effects model. Treatment efficacies were measured by determining locoregional recurrence (LRR). Secondary outcomes included transient recurrent laryngeal nerve (RLN) injury, permanent RLN injury, transient hypocalcemia, and permanent hypocalcemia. Results Twenty-three retrospective and prospective cohort studies involving 18,376 patients were reviewed. Patients who underwent pCND had significantly lower LRR (odds ratio [OR] 0.65; 95% confidence interval [CI] 0.48–0.88) but significantly higher incidence rates of transient RLN injury (OR 2.03; 95% CI 1.32–3.13), transient hypocalcemia (OR 2.23; 95% CI 1.84–2.70), and permanent hypocalcemia (OR 2.22; 95% CI 1.58–3.13) than that of no pCND group. Conclusion Compared with no pCND, pCND significantly reduces LRR but is accompanied by numerous adverse effects. The clinical decision should be made after the shared decision-making process of clinicians and patients.