Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan 14:11:803986.
doi: 10.3389/fonc.2021.803986. eCollection 2021.

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

Xing-Qiang Yan  1 , Zhen-Zhen Zhang  2 , Wen-Jie Yu  1 , Zhao-Sheng Ma  1 , Min-Long Chen  1 , Bo-Jian Xie  1
Affiliations

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

Xing-Qiang Yan et al. Front Oncol. .

Abstract

Background: The 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.

Methods: A 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.

Results: We 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).

Conclusions: This 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 registration: https://www.crd.york.ac.uk/PROSPERO/, CRD42021281825.

Keywords: lateral cervical lymph node metastases; lateral neck dissection (LND); locoregional recurrence; papillary thyroid carcinoma (PTC); prophylactic central neck dissection (PCND); total thyroidectomy (TT).

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of article selection according to PRISMA statement.
Figure 2
Figure 2
Forest plot showing a meta-analysis of locoregional recurrence (LRR) for included studies. (A) Central neck recurrence; (B) Lateral neck recurrence; (C) overall recurrence.
Figure 3
Figure 3
Forest plot showing a meta-analysis of postoperative complications for included studies. (A) Permanent laryngeal nerve palsy; (B) permanent hypoparathyroidism; (C) overall complications.
See this image and copyright information in PMC

References

    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. . Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: Cancer J Clin (2021) 71(3):209–49. doi: 10.3322/caac.21660 - DOI - PubMed
    1. Randolph GW, Duh QY, Heller KS, LiVolsi VA, Mandel SJ, Steward DL, et al. . The Prognostic Significance of Nodal Metastases From Papillary Thyroid Carcinoma can be Stratified Based on the Size and Number of Metastatic Lymph Nodes, as Well as the Presence of Extranodal Extension. Thyroid (2012) 22(11):1144–52. doi: 10.1089/thy.2012.0043 - DOI - PubMed
    1. Thompson AM, Turner RM, Hayen A, Aniss A, Jalaty S, Learoyd DL, et al. . A Preoperative Nomogram for the Prediction of Ipsilateral Central Compartment Lymph Node Metastases in Papillary Thyroid Cancer. Thyroid (2014) 24(4):675–82. doi: 10.1089/thy.2013.0224 - DOI - PMC - PubMed
    1. Pereira JA, Jimeno J, Miquel J, Iglesias M, Munné A, Sancho JJ, et al. . Nodal Yield, Morbidity, and Recurrence After Central Neck Dissection for Papillary Thyroid Carcinoma. Surgery (2005) 138(6):1095–100, discussion 100-1. doi: 10.1016/j.surg.2005.09.013 - DOI - PubMed
    1. National Comprehensive Cancer Network . NCCN Clinicial Practice Guidelines in Oncology—Thyroid Carcinoma. Available at: https://wwwnccnorg/ (Accessed 1 September 2021).

Publication types

LinkOut - more resources