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Meta-Analysis
. 2017 Feb;37(1):1-8.
doi: 10.14639/0392-100X-1195.

Is prophylactic central neck dissection necessary for cN0 differentiated thyroid cancer patients at initial treatment? A meta-analysis of the literature

J Liang  1 , Z Li  1 , F Fang  1 , T Yu  2 , S Li  1
Affiliations
Meta-Analysis

Is prophylactic central neck dissection necessary for cN0 differentiated thyroid cancer patients at initial treatment? A meta-analysis of the literature

J Liang et al. Acta Otorhinolaryngol Ital. 2017 Feb.

Abstract
in English, Italian

Central lymph node metastases are common in patients with differentiated thyroid cancer (DTC). The management of preoperatively nodenegative (cN0) DTC is still under debate. The aim of this study was to analyse the difference in recurrence and surgical complications between thyroidectomy (TT) alone and TT combined with prophylactic central neck dissection (pCND) as initial treatments to DTC patients with cN0 and evaluate the clinic significance of pCND for these patients. PubMed, Ovid, Cochrane Library, and Web of Science databases were systematically searched using multiple search terms. Twenty-three articles with 6,823 patients were identified. The quality of evidence was assessed by Jadad quality scores and the Newcastle-Ottawa Quality assessment scale. The results showed that compared with patients who underwent TT alone, patients who underwent TT plus pCND had a significant higher rate of transient recurrent laryngeal nerve injury (p = 0.023), transient hypocalcaemia (p < 0.01) and permanent hypocalcaemia (p<0.01). There was a trend towards lower central neck recurrence rate in TT plus pCND (p < 0.01). Combined TT and pCND as initial treatment for DTC patients with cN0 may reduce the risk of recurrence, but increases the incidence of some complications. Methodologically high-quality comparative studies are needed for further evaluation.

Le metastasi ai linfonodi del compartimento centrale del collo sono comuni nei pazienti affetti da carcinoma differenziato della tiroide (DTC). La gestione dei pazienti con stadiazione preoperatoria cN0 è ancora dibattuta. L’obiettivo di questo lavoro è stato quello di analizzare le differenze in merito a ricorrenza e complicanze chirurgiche tra tiroidectomia (TT) isolata e TT associata a svuotamento linfonodale profilattico del compartimento centrale del collo (pCND) come trattamenti iniziali di pazienti con DTC cN0, e di valutare l’importanza clinica del pCND per questi pazienti. I database PubMed, Ovid, Cochrane Library e Web of Science sono stati analizzati scrupolosamente, e sono stati identificati ventitré articoli per un totale di 6823 pazienti. La qualità di evidenza è stata valutata tramite lo score di Jadad e tramite la Newcastle-Ottawa Quality assessment scale. I risultati hanno mostrato che i pazienti sottoposti a TT e pCND, se paragonati ai pazienti sottoposti a TT isolata, hanno avuto un tasso significativamente più alto di lesioni transitorie del nervo laringeo inferiore (p = 0,023), di ipocalcemia transitoria (p < 0,01) e di ipocalcemia permanente (p < 0,01). Inoltre è stato rilevato un trend in diminuzione per quel che riguarda il tasso di ricorrenza nei pazienti sottoposti a TT e pCND (p < 0,01). La tiroidectomia totale associata allo svuotamento del compartimento centrale del collo come trattamento iniziale per quei pazienti con cN0 potrebbe ridurre il rischio di ricorrenza di malattia, ma aumenta l’incidenza di alcune complicanze. Si rendono necessari ulteriori studi di maggior qualità metodologica.

Keywords: Differentiated thyroid cancer; Meta-analysis; Prophylactic central neck dissection; cN0.

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Figures

Fig. 1.
Fig. 1.
Forest plot of risk ratio for transient RLN injury.
Fig. 2
Fig. 2
Begg's funnel plot for visual assessment of overt publication bias for transient RLN injury.
Fig. 3
Fig. 3
Egger's publication bias plot showed no publication bias for transient RLN injury.
See this image and copyright information in PMC

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