Prophylactic Central Neck Dissection for Clinically Node‐Negative Papillary Thyroid Carcinoma

Abstract

Objective: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that scrutinized the oncological benefits and postsurgical complications of total thyroidectomy (TT) plus prophylactic central neck dissection (pCND) versus TT alone among clinically node-negative (cN0) papillary thyroid cancer (PTC) patients.Methods: We screened five databases from inception to September 4, 2021 and evaluated the risk of bias of the eligible studies. We pooled dichotomous outcomes using the risk ratio (RR) with 95% confidence interval (CI).Results: Overall, we included 5 RCTs with low risk of bias comprising 795 patients (TT plus pCND = 410 and TT alone = 385). With regard to efficacy endpoint, the rate of structural loco-regional recurrence did not significantly differ between both groups (n = 4 RCTs, RR = 0.49, 95% CI [0.19, 1.27], P = .14). With regard to safety endpoints, the rates of hypoparathyroidism (n = 5 RCTs, RR = 1.48, 95% CI [0.73, 2.97], P = .27), recurrent laryngeal nerve injury (n = 5 RCTs, RR = 1.34, 95% CI [0.59, 3.03], P = .48), and bleeding (n = 3 RCTs, RR = 1.75, 95% CI [0.42, 7.26], P = .44) did not significantly differ between both groups.Conclusion: For cN0 PTC patients, there was no significant difference between TT plus pCND and TT alone with regard to the rate of structural loco-regional recurrence or frequency of postsurgical complications. Adaptation of pCND in cN0 PTC patients should be contemplated by taking into consideration the clinical oncological benefits and rate of postsurgical adverse events.

Papillary Thyroid Microcarcinoma: A Nomogram Based on Clinical and Ultrasound Features to Improve the Prediction of Lymph Node Metastases in the Central Compartment

“…According to Chinese Guidelines for Diagnosis and Treatment of Differentiated Thyroid Cancer (2012), lobectomy and prophylactic CLND was recommended for patients with tumors <1 cm in size. However, previous studies had shown that preventive CLND does not significantly benefit patients with low-risk PTC ( 16 , 17 ). It was suggested that active surveillance rather than surgery could be taken for low-risk PTMC by the guidelines of the American Thyroid Association (2015) ( 2 ).…”

Prophylactic Central Neck Lymph Node Dissection Adds No Short-Term Benefit to Total Thyroidectomy for Differentiated Thyroid Cancer

“…Another particular concern is metastasis to clinically and radiologically negative neck nodes in DTC patients. To the best of our knowledge, three recent systematic reviews of randomized trials with meta-analysis had demonstrated the absence of benefit of pCNLD in thyroid cancer patients with cN0 undergoing TT (despite the fact that central lymph node metastasis CLNM may be as high as 40% in this patient group and has been found to be associated with poor prognosis) [ 15 , 16 , 17 ].…”

Effect of prophylactic central neck dissection following total thyroidectomy on surgical site wound infection, hematoma, and haemorrhage in subjects with clinically node‐negative papillary thyroid carcinoma: A meta‐analysis

“…This was suggested also in a previous similar metaanalyses study which showed similar promising outcomes for prophylactic central neck dissection following total thyroidectomy in improving the haemorrhage and reducing the surgical site wound infection. [56][57][58][59] Well-conducted randomised controlled trials are needed to assess these factors and the combination of different ages, ethnicity, and other variants of subjects; because our meta-analysis study could not answer whether different ages, ethnicity, and gender are related to the results.…”

“…This was suggested also in a previous similar meta‐analyses study which showed similar promising outcomes for prophylactic central neck dissection following total thyroidectomy in improving the haemorrhage and reducing the surgical site wound infection. 56 , 57 , 58 , 59 …”