Total Thyroidectomy Versus Conventional Surgery For Differential Thyroid Carcinoma: A Meta-analysis On Curative Effect

Objective：Thyroid carcinoma is the most common endocrine system malignanttumors, more than90%for differentiated thyroid carcinoma. Surgical resection is theprimary method of treatment of differentiated thyroid carcinoma. However, at home andabroad for differentiated thyroid carcinoma manner and extent of surgical resection isstill holding different views. Europe and other Western countries are currently scholarsadvocated total thyroidectomy or near-total thyroidectomy as it is main procedure, andour Asia-Pacific region and Japan, although there are many scholars advocated totalthyroidectomy or near-total thyroidectomy as it is mainstream procedure, but subtotalresection and thyroid gland isthmus resection still got a lot of respected scholars.Therefore, this study by comparing these two surgical recurrence rate and complicationrate and after5-years,10-year survival rates and other indicators is to explore the bestway for differentiated thyroid cancer surgical resection. As to provide theoretical basisfor clinical doctors to choose reasonable operation.Method：According to the strict literature into and exclusion criteria, we weresystem searched PubMed, Medline, Ovid, Springer, EBASE, Cochrane Librarydatabases, such as foreign language and Chinese HowNet, Articles, VIP and otherChinese database, and ultimately into the literature after reading the full text. Used theNewcastle-Ottawa Scale (NOS) Scale to evaluate the quality of which studies includedand used a unified document information extraction table to extract data. Recurrencerate is the primary outcome indicators.Postoperative recurrent laryngeal nerve injuryand postoperative hypothyroidism and after5-year and10-year survival as the secondary outcomes indicators. Applicated RevMan5.2software to data analysis.Selected odds ratio (odd ratio, OR) and95%confidence intervals (Confidence interval,CI) with Count Data. and Measurement data with weighted mean difference (weightedmean difference, WMD) and95%confidence intervals (Confidence interval, CI). Wewere according to the data analysis results to draw funnel plot. Used a fixed effectsmodel or random effects model to analyze the data with Meta-analysis. As P=0.05wasthe level of test. P <0.05was considered statistically significant.Result: Finally we included24literatures. The overall quality of literatureswere moderate. We included12,701cases in our study. The outcome ofMeta-analysis:(1)Compared with subtotal thyroidectomy or gland lobectomy plusisthmus resection, total thyroidectomy for differentiated thyroid carcinoma can reducethe postoperative recurrence rate, the result is [OR=0.41（95%CI：0.20,0.86），P=0.02]和[OR=0.30（95%CI：0.16,0.55），P<0.0001];(2) Compared with subtotalthyroidectomy or gland lobectomy plus isthmus resection, total thyroidectomy fordifferentiated thyroid carcinoma can increase postoperative recurrent laryngeal nerveinjury, the result is [OR=1.69（95%CI：1.31,2.18），P<0.0001]和[OR=2.94（95%CI：1.25,6.91），P=0.01];(3) Compared with subtotal thyroidectomy or gland lobectomyplus isthmus resection,total thyroidectomy for differentiated thyroid carcinoma canincrease postoperative hypoparathyroidism,the result is[OR=4.08（95%CI：1.85,8.96），P=0.0005]和[OR=6.52（95%CI：2.51,16.97），P=0.0001];(4)The five-year survival ratewas no statistically significant with the differentiated thyroid carcinoma patients whowere operated after total thyroidectomy or subtotal thyroidectomy or gland lobectomyplus isthmus resection, the results is [OR=1.45(95%CI:0.73,2.88), P=0.29]；Alsothe10-year survival rate was not statistically significant, the results is [OR=0.97(95%CI:0.44,2.17), P=0.95].Conclusion：In differentiated thyroid cancer therapy, the recurrence rate after totalthyroidectomy is low, but a higher postoperative complications (recurrent laryngealnerve injury and hypoparathyroidism). The recurrence rate after subtotal thyroidectomyor gland lobectomy plus isthmus resection is high, but a lower complication. There was no significant difference between the above two group of surgical methods onpostoperative5-year and10-year survival rate.We still can not draw what procedure hasan absolute advantage in differentiated thyroid cancer surgery treatment.