Carbon Nanoparticles for Thyroidectomy and Central Lymph Node Dissection for Thyroid Cancer

Abstract

Purpose To evaluate whether the application of carbon nanoparticles (CNs) in total or near-total thyroidectomy combined with central lymph node dissection (CLND) for thyroid cancer (TC) is beneficial to lymph node dissection, parathyroid, and recurrent laryngeal nerve (RLN) protection. Methods Relevant literatures were systematically searched on PubMed, EMBASE, and Cochrane Library Databases until March 31, 2021. All analyses were performed using Revman Manager 5.3 software. The main results were the number of central lymph nodes, the number of central metastatic lymph nodes, accidental parathyroidectomy, postoperative hypoparathyroidism, postoperative hypocalcemia, and postoperative transient RLN paralysis. Results This meta-analysis identified 4 randomized controlled trials and 8 non-randomized controlled trials comprising 1870 patients. Compared with the control, the use of CNs was helpful to dissect more central lymph nodes (weighted mean difference [WMD]: 3.55, 95% confidence interval [CI]: 2.12-4.98, P < .00001) and central metastatic lymph nodes (WMD: 1.69, 95% CI:1.31-2.08, P < .00001), lower rate of accidental parathyroidectomy (odds ratio [OR]: .33, 95% CI: .23-.47, P < .00001), lower rate of both postoperative transient hypoparathyroidism (OR: .40, 95% CI: .31-.51, P < .00001), and transient hypocalcemia (OR: .37, 95% CI: .27-.51, P < .00001). However, there were no statistical difference between the groups for postoperative permanent hypoparathyroidism (OR: .29, 95% CI: .06-1.28, P = .10), postoperative permanent hypocalcemia (OR: .94, 95% CI: .10-9.16, P = .96), and postoperative transient RLN paralysis (OR: .66, 95% CI: .40-1.12, P = .12). Conclusions The application of CNs in total or near-total thyroidectomy combined with CLND for TC can better dissect the central lymph nodes and protect parathyroid glands (PGs) and their function.

Carbon nanoparticles beneficial for prophylactic central compartment lymph node dissection in cN0 papillary thyroid carcinoma

“…A significantly higher rate of metastatic lymph nodes harvest could be achieved with the help of CNP (35.5 % Vs 28.8 %, p = 0.047), which could be associated with less chance of recurrence in the central neck. Furthermore, CNP could not only facilitate achieving more thorough dissection, but also help in reducing hypocalcemia and hypoparathyroidism, which was consistent with the literature [ 9 ]. The median incidence of temporary and permanent hypocalcemia after TT was reported to be 27 % (19–38 %) and 1 % (0–3%), respectively, by a meta-analysis of 115 studies [ 19 ].…”

“…Additionally, the position of inferior PTGs could be quite variable, and it is often difficult to distinguish them from lymph nodes, adipose tissue, and PTGs in the surgical field of CCLND. Furthermore, blood vessels supplying PTGs are small and fragile and vulnerable to surgical manipulation, possibly causing ischemia or even necrosis of PTGs [ 9 ]. It is our assumption that although CNP would cost a little more than ＄200, its potential benefit could compensate.…”

“…However, according to the literature, this approach has numerous adverse effects, including temporary and permanent hypoparathyroidism and temporary recurrent laryngeal nerve (RLN) injury [ 5 , 6 ]. Carbon nanoparticles (CNP) have been introduced in recent years, which are associated with a higher number of harvested lymph nodes and a lower rate of accidental parathyroid gland (PTG) removal [ [7] , [8] , [9] ]. Hence, CNP has been suggested in thyroid cancer surgery on a broader scale [ 7 ].…”

Application of preoperative ultrasound-guided injection of nano-carbon for central lymph node dissection in papillary thyroid carcinoma

“…The completeness in dissection of pretracheal and paratracheal lymph nodes depends on surgical competence and skill. In the recent decade, nano-carbon has been demonstrated to be e cient in thyroid surgeries, leading to more extensive lymph node dissection [20,21,22]. In our study, the number of retrieved pretracheal and paratrachinal lymph nodes is larger in the POI group than in the IOI group.…”

Observation of Clinical Effects of 3D Endoscopy in Total Thyroidectomy and Central Lymph Node Dissection

“…A comparative analysis was conducted on the incidence of adverse reactions and clinical effects between the two groups [2].…”