Annals of Surgical Oncology

, Volume 20, Issue 11, pp 3477–3483 | Cite as

A Meta-analysis of the Effect of Prophylactic Central Compartment Neck Dissection on Locoregional Recurrence Rates in Patients with Papillary Thyroid Cancer

  • Tracy S. WangEmail author
  • Kevin Cheung
  • Forough Farrokhyar
  • Sanziana A. Roman
  • Julie Ann Sosa
Endocrine Tumors



It is not known whether prophylactic central compartment neck dissection (pCCND) in conjunction with total thyroidectomy decreases rates of locoregional recurrence in patients with papillary thyroid cancer (PTC).


A meta-analysis was performed of reported recurrence rates of clinically node-negative PTC in patients treated with total thyroidectomy (TT) alone, or TT and pCCND. The primary outcome was locoregional recurrence of PTC.


Eleven studies capturing 2,318 patients met the inclusion criteria. Overall, the recurrence rate for patients undergoing TT/pCCND was 3.8 % [95 % confidence interval (CI) 2.3–5.8]. In the six comparative studies, which included 1,740 patients, 995 patients undergoing TT and 745 patients undergoing TT/pCCND, the overall recurrence rate was 7.6:7.9 % in the TT group and 4.7 % in the TT/pCCND group. The relative risk of recurrence was 0.59 (95 % CI 0.33–1.07), favoring a lower recurrence rate in the TT/pCCND arm. The number of patients that would need to be treated (NNT) in order to prevent a single recurrence is 31. The relative risk for permanent hypocalcemia was 1.82 (95 % CI 0.51–6.5) and for permanent recurrent laryngeal nerve injury was 1.14 (95 % CI 0.46–2.83).


There was no difference in recurrence or long-term complication rates between patients undergoing TT or TT/pCCND. There was a trend toward lower recurrence rates in TT/pCCND patients, with a NNT of 31 patients. On the basis of these data, routine pCCND might be considered in the hands of high-volume surgeons treating patients with clinically node-negative PTC.


Total Thyroidectomy Papillary Thyroid Cancer Locoregional Recurrence Central Neck Recurrent Laryngeal Nerve Injury 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors declare no conflict of interest.


  1. 1.
    Cooper DS, Doherty GM, Haugen BR, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2009;19:1167–214.PubMedCrossRefGoogle Scholar
  2. 2.
    Kouvaraki MA, Shapiro SE, Fornage BD, et al. Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery. 2003;134:946–54.PubMedCrossRefGoogle Scholar
  3. 3.
    National Comprehensive Cancer Network. Thyroid carcinoma, version 1.2013. Accessed April 2013.
  4. 4.
    Gyorki DE, Untch B, Tuttle RM, Shaha AR (2013) Prophylactic central neck dissection in differentiated thyroid cancer: an assessment of the evidence. Ann Surg Oncol. 2013;20:2285–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Cisco RM, Shen WT, Gosnell JE. Extent of surgery for papillary thyroid cancer: preoperative imaging and role of prophylactic and therapeutic neck dissection. Curr Treat Options Oncol. 2012;13:1–10.PubMedCrossRefGoogle Scholar
  6. 6.
    Carling T, Long WD 3rd, Udelsman R. Controversy surrounding the role for routine central lymph node dissection for differentiated thyroid cancer. Curr Opin Oncol. 2010;22:30–4.PubMedCrossRefGoogle Scholar
  7. 7.
    Evans DB. Papillary carcinoma of the thyroid: balancing principles of oncology with emerging technology. Surgery. 2011;150:1015–22.PubMedCrossRefGoogle Scholar
  8. 8.
    Schlumberger M, Hitzel A, Toubert ME, et al. Comparison of seven serum thyroglobulin assays in the follow-up of papillary and follicular thyroid cancer patients. J Clin Endocrinol Metab. 2007;92:2487–95.PubMedCrossRefGoogle Scholar
  9. 9.
    Stulak JM, Grant CS, Farley DR, et al. Value of preoperative ultrasonography in the surgical management of initial and reoperative papillary thyroid cancer. Arch Surg. 2006;141:489–94.PubMedCrossRefGoogle Scholar
  10. 10.
    Barczynski M, Konturek A, Stopa M, Nowak W. Prophylactic central neck dissection for papillary thyroid cancer. Br J Surg. 2013;100:410–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Lang BH, Wong KP, Wan KY, Lo CY. Impact of routine unilateral central neck dissection on preablative and postablative stimulated thyroglobulin levels after total thyroidectomy in papillary thyroid carcinoma. Ann Surg Oncol. 2012;19:60–7.PubMedCrossRefGoogle Scholar
  12. 12.
    Moo TA, McGill J, Allendorf J, Lee J, Fahey T 3rd, Zarnegar R. Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma. World J Surg. 2010;34:1187–91.PubMedCrossRefGoogle Scholar
  13. 13.
    Hughes DT, White ML, Miller BS, Gauger PG, Burney RE, Doherty GM. Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer. Surgery. 2010;148:1100–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Costa S, Giugliano G, Santoro L, et al. Role of prophylactic central neck dissection in cN0 papillary thyroid cancer. Acta Otorhinolaryngol Ital. 2009;29:61–9.PubMedGoogle Scholar
  15. 15.
    Son YI, Jeong HS, Baek CH, et al. Extent of prophylactic lymph node dissection in the central neck area of the patients with papillary thyroid carcinoma: comparison of limited versus comprehensive lymph node dissection in a 2-year safety study. Ann Surg Oncol. 2008;15:2020–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Sywak M, Cornford L, Roach P, Stalberg P, Sidhu S, Delbridge L. Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery. 2006;140:1000–5.PubMedCrossRefGoogle Scholar
  17. 17.
    Zaydfudim V, Feurer ID, Griffin MR, Phay JE. The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma. Surgery. 2008;144:1070–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Leboulleux S, Rubino C, Baudin E, et al. Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and/or tumor extension beyond the thyroid capsule at initial diagnosis. J Clin Endocrinol Metab. 2005;90:5723–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Koo BS, Choi EC, Yoon YH, Kim DH, Kim EH, Lim YC. Predictive factors for ipsilateral or contralateral central lymph node metastasis in unilateral papillary thyroid carcinoma. Ann Surg. 2009;249:840–4.PubMedCrossRefGoogle Scholar
  20. 20.
    Roh JL, Kim JM, Park CI. Central lymph node metastasis of unilateral papillary thyroid carcinoma: patterns and factors predictive of nodal metastasis, morbidity, and recurrence. Ann Surg Oncol. 2011;18:2245–50.PubMedCrossRefGoogle Scholar
  21. 21.
    Laird AM, Gauger PG, Miller BS, Doherty GM. Evaluation of postoperative radioactive iodine scans in patients who underwent prophylactic central lymph node dissection. World J Surg. 2012;36:1268–73.PubMedCrossRefGoogle Scholar
  22. 22.
    Lang BH, Yih PC, Shek TW, Wan KY, Wong KP, Lo CY. Factors affecting the adequacy of lymph node yield in prophylactic unilateral central neck dissection for papillary thyroid carcinoma. J Surg Oncol. 2012;106:966–71.PubMedCrossRefGoogle Scholar
  23. 23.
    Carling T, Carty SE, Ciarleglio MM, et al. American thyroid association design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma. Thyroid. 2012;22:237–44.PubMedCrossRefGoogle Scholar
  24. 24.
    Zetoune T, Keutgen X, Buitrago D, et al. Prophylactic central neck dissection and local recurrence in papillary thyroid cancer: a meta-analysis. Ann Surg Oncol. 2010;17:3287–93.PubMedCrossRefGoogle Scholar
  25. 25.
    Shan CX, Zhang W, Jiang DZ, Zheng XM, Liu S, Qiu M. Routine central neck dissection in differentiated thyroid carcinoma: a systematic review and meta-analysis. Laryngoscope. 2012;122:797–804.PubMedCrossRefGoogle Scholar
  26. 26.
    Lang BH, Ng SH, Lau L, Cowling B, Wong KP, Wan KY. A systematic review and meta-analysis of prophylactic central neck dissection on short-term locoregional recurrence in papillary thyroid carcinoma after total thyroidectomy. Thyroid. 2013. doi: 10.1089/thy.2012.0608.
  27. 27.
    Moher D, Liberati A, Tetzlaff J, Altman D. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6:1–6.CrossRefGoogle Scholar
  28. 28.
    Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J. Methodological index for non-randomized studies (MINORS): development and validation of a new instrument. ANZ J Surg. 2003;73:712–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Wang TS, Evans DB, Fareau GG, Carroll T, Yen TW. Effect of prophylactic central compartment neck dissection on serum thyroglobulin and recommendations for adjuvant radioactive iodine in patients with differentiated thyroid cancer. Ann Surg Oncol. 2012;19:4217–22.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2013

Authors and Affiliations

  • Tracy S. Wang
    • 1
    Email author
  • Kevin Cheung
    • 2
  • Forough Farrokhyar
    • 2
    • 3
  • Sanziana A. Roman
    • 4
  • Julie Ann Sosa
    • 4
  1. 1.Department of SurgeryMedical College of WisconsinMilwaukeeUSA
  2. 2.Department of SurgeryMcMaster UniversityHamiltonCanada
  3. 3.Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada
  4. 4.Department of SurgeryDuke University School of MedicineDurhamUSA

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