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The Effect of Prophylactic Central Neck Dissection on Locoregional Recurrence in Papillary Thyroid Cancer After Total Thyroidectomy: A Systematic Review and Meta-Analysis

pCND for the Locoregional Recurrence of Papillary Thyroid Cancer

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The use of prophylactic central neck dissection (pCND) for papillary thyroid cancer (PTC) without clinical evidence of nodal metastasis (cN0) remains controversial. This study was designed to examine whether pCND for PTC affected locoregional recurrence (LRR).

Methods

A systematic review was performed to compare the LRR between patients with PTC who underwent total thyroidectomy (TT) and pCND and those who underwent TT alone. The primary outcome was LRR. Other outcomes, including postoperative radioiodine (RAI) ablation and surgically related complications, were evaluated. A meta-analysis was performed using the random-effects model.

Results

We included 17 studies, which comprised 4437 patients. Patients in the TT+pCND group had a significantly reduced risk of LRR (risk ratio [RR] = 0.66; 95% confidence interval [CI]: 0.49–0.90; P = 0.008). The LRR in the central neck compartment (RR = 0.35; 95% CI 0.18–0.68; P = 0.002) was significantly lower in the TT+pCND group, whereas the LRR in the lateral neck compartment was similar between the two groups. Compared with the TT alone group, patients in the TT+pCND group tended to receive higher RAI (74.6% vs. 59.9%) and experience temporary hypocalcemia (odds ratio [OR] = 2.37; 95% CI 1.89–2.96; P < 0.00001), permanent hypocalcemia (OR = 1.93; 95% CI 1.05–3.57; P = 0.03), and increased overall morbidity (OR = 2.56; 95% CI 1.75–3.74; P < 0.00001).

Conclusions

This meta-analysis suggested that although pCND reduced the LRR in PTC—specifically in the central neck compartment—it was accompanied by an increased rate of postoperative hypocalcemia. However, the evidence is limited and randomized, controlled trials are needed to clarify this role further.

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Acknowledgement

This work is supported by the grants from the CAMS Innovation Fund for Medical Sciences (CIFMS, 2016-I2M-3-005). The authors thank Dr. Lin Ma (Department of General Surgery, Peking Union Medical College Hospital) for furnishing data.

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    Authors and Affiliations

    1. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China

      Wenjing Zhao MD, Lei You MD, Xianming Hou MD, Shaobo Chen MD, Xiaoxia Ren PhD, Ge Chen MD & Yupei Zhao MD

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    1. Wenjing Zhao MD
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    Correspondence to Ge Chen MD or Yupei Zhao MD.

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    Wenjing Zhao and Lei You contributed equally to this article.

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    Zhao, W., You, L., Hou, X. et al. The Effect of Prophylactic Central Neck Dissection on Locoregional Recurrence in Papillary Thyroid Cancer After Total Thyroidectomy: A Systematic Review and Meta-Analysis. Ann Surg Oncol 24, 2189–2198 (2017). https://doi.org/10.1245/s10434-016-5691-4

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    • DOI: https://doi.org/10.1245/s10434-016-5691-4

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