Prophylactic Central Neck Dissection for cN1b Papillary Thyroid Carcinoma: A Systematic Review and Meta-Analysis

Abstract

BackgroundThe value of prophylactic central neck dissection (PCND) for papillary thyroid carcinoma (PTC) with clinically evident lateral cervical lymph node metastases (cN1b) remains unclear. Therefore, a systematic review and meta-analysis was conducted to assess the efficacy and safety of PCND.MethodsA comprehensive systematic search was conducted on PubMed, Web of Science, Cochrane library and Embase databases up to September 2021 to identify eligible studies. Controlled clinical trials assessing therapeutic effects and safety of PCND for cN1b PTC patients were included. The risk of bias for each cohort study was assessed using the Newcastle-Ottawa Scale (NOS). The primary outcomes were indexes related to the locoregional recurrence (LRR) and surgical complications. Review Manager software V5.4.0 was used for statistical analysis. A fixed effects model was adopted for the data without heterogeneity, otherwise a random effects model was used.ResultsWe included 4 retrospective cohort studies, which comprised 483 PTC patients. There was no statistically significant difference in the central neck recurrence (CNR) (10.2% vs. 3.8%, relative risk (RR) = 1.82; 95%CI 0.90–3.67; P = 0.09), lateral neck recurrence (LNR) (5.1% vs. 7.7%, RR = 0.47; 95% CI 0.13–1.74; P = 0.26), and overall recurrence (OR) (18.9% vs. 16.9%, RR = 0.77; 95%CI 0.34–1.76; P = 0.54), between LND + PCND group and LND group. Simultaneously, PCND increased the risk of permanent hypoparathyroidism (11.4% vs. 4.5%, RR = 2.70, 95%CI 1.05–6.94; P = 0.04) and overall complications (17.0% vs. 5.3%, RR = 3.28; 95%CI 1.37–7.86; P = 0.008).ConclusionsThis meta-analysis showed that PCND did not have any advantage in preventing LRR for cN1b PTC. Meanwhile, PCND may result in the increased rate of surgical complications. However, the current evidence is limited and more clinical trials are still needed to further clarify the true role of PCND.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, CRD42021281825.

Intraoperative quantitative assessment of parathyroid blood flow during total thyroidectomy using indocyanine green fluorescence imaging ‐ surgical strategies for preserving the function of parathyroid glands

“…We show that LND was a risk factor for postoperative hypoparathyroidism. In patients who underwent simultaneous LND with CND, preservation of blood flow during neck dissection may be difficult, consistent with the previous reports 27,28 …”

“…In patients who underwent simultaneous LND with CND, preservation of blood flow during neck dissection may be difficult, consistent with the previous reports. 27,28 In recent years, a variety of new techniques have been reported…”

Preoperative Cervical Lymph Node Metastasis Prediction in Papillary Thyroid Carcinoma: A Noninvasive Clinical Multimodal Radiomics (CMR) Nomogram Analysis

“…Although CND improves disease-specifc survival and reduces local recurrence in cases of LNM [9], prophylactic CND has been reported to not improve long-term outcomes and is related to high hypoparathyroidism rates [10]. Given the increasing awareness about the substantial impact of PTC overdiagnosis, the guidelines of the American Tyroid Association (ATA) recommended and advocated thyroid lobectomy alone and active surveillance as initial treatments for low-risk PTC patients [11].…”

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

“…4 Furthermore, even in cN1b PTC, pCND did not significantly reduce locoregional recurrence (p = 0.09) but was associated with a higher rate of permanent hypoparathyroidism (p = 0.04) and overall complications (p = 0.008). 5 Recent studies have examined the efficacy and safety of pCND in low-risk PTC. Multiple meta-analyses found no significant improvement in disease-free survival (p = 0.38) or overall survival (p = 0.91) with pCND.…”

“…However, they observed increased risks of complications, including hypoparathyroidism (p < 0.001) and RLN injury (p = 0.002). 6 Furthermore, a large retrospective multicenter study involving 3,214 patients failed to resolve this issue. It showed that pCND did not significantly reduce the risk of locoregional recurrence in cN0 lateral neck (p = 0.498).…”