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World Journal of Surgery

, Volume 42, Issue 9, pp 2846–2857 | Cite as

Prophylactic Central Neck Dissection for Papillary Thyroid Carcinoma with Clinically Uninvolved Central Neck Lymph Nodes: A Systematic Review and Meta-analysis

  • Lawrence Chen
  • Yi-Hsiu Wu
  • Chia-Hwa Lee
  • Hsin-An Chen
  • El-Wui Loh
  • Ka-Wai Tam
Original Scientific Report
  • 249 Downloads

Abstract

Background

Central neck dissection and total thyroidectomy are standard treatments for patients with papillary thyroid carcinoma (PTC) with clinically involved central nodes. However, prophylactic central neck dissection (pCND) in patients with clinically uninvolved cN0 has been beneficial in some studies but ineffective in others. We conducted a meta-analysis to evaluate the efficacy and safety of pCND in patients with central neck lymph nodes cN0 PTC.

Methods

The PubMed, EMBASE, Cochrane Library, and Scopus databases and the ClinicalTrials.gov registry were electronically searched for studies published until September 2017. The meta-analysis was conducted to calculate the pooled effect size by using random-effects model. Treatment efficacies were measured by determining locoregional recurrence (LRR). Secondary outcomes included transient recurrent laryngeal nerve (RLN) injury, permanent RLN injury, transient hypocalcemia, and permanent hypocalcemia.

Results

Twenty-three retrospective and prospective cohort studies involving 18,376 patients were reviewed. Patients who underwent pCND had significantly lower LRR (odds ratio [OR] 0.65; 95% confidence interval [CI] 0.48–0.88) but significantly higher incidence rates of transient RLN injury (OR 2.03; 95% CI 1.32–3.13), transient hypocalcemia (OR 2.23; 95% CI 1.84–2.70), and permanent hypocalcemia (OR 2.22; 95% CI 1.58–3.13) than that of no pCND group.

Conclusion

Compared with no pCND, pCND significantly reduces LRR but is accompanied by numerous adverse effects. The clinical decision should be made after the shared decision-making process of clinicians and patients.

Notes

Acknowledgements

We acknowledge Wallace Academic Editing for editing this manuscript.

Funding

This work was supported by a research grant from Shuang Ho Hospital, Taipei Medical University (Grant No.: 106SHHR02). The sponsoring organization was not involved in the study design, data analysis, or interpretation.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest or financial ties to disclose.

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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Lawrence Chen
    • 1
  • Yi-Hsiu Wu
    • 2
  • Chia-Hwa Lee
    • 3
    • 4
    • 5
  • Hsin-An Chen
    • 2
    • 6
  • El-Wui Loh
    • 7
  • Ka-Wai Tam
    • 2
    • 6
    • 7
    • 8
  1. 1.Lake Erie College of Osteopathic MedicineBradentonUSA
  2. 2.Division of General Surgery, Department of Surgery, Shuang Ho HospitalTaipei Medical UniversityNew Taipei CityTaiwan
  3. 3.School of Medical Laboratory Science and Biotechnology, College of Medical Science and TechnologyTaipei Medical UniversityTaipeiTaiwan
  4. 4.Comprehensive Cancer Center of Taipei Medical UniversityTaipeiTaiwan
  5. 5.Department of Laboratory Medicine, Shuang Ho HospitalTaipei Medical UniversityTaipeiTaiwan
  6. 6.Department of Surgery, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
  7. 7.Center for Evidence-Based Health Care, Shuang Ho HospitalTaipei Medical University 291New Taipei CityTaiwan
  8. 8.Cochrane TaiwanTaipei Medical UniversityTaipeiTaiwan

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