Meta-analysis Of Efficacy And Safety Of PCND In Patients With CN0 Papillary Thyroid Adenocarcinoma

Objective: This study conducted a meta-analysis to investigate the efficacy and safety of prophylactic central lymph node dissection(prophylactic central neck dissection,PCND)in patients with thyroid papillary carcinoma with clinical negative lymph nodes(c N0),in order to provide evidence for whether PCND should be routinely performed in clinic.Methods: Relevant literatures were retrieved from electronic databases EMBASE,Cochrane Library,PubMed,CNKI and Web Of Science,and the time limit was from January 2000 to December 2022.The quality assessment and data extraction of literatures meeting the criteria were carried out,and the analysis was carried out using Revman5.4 software.The incidence of local recurrence,parathyroid dysfunction(permanent and temporary),LNR(permanent and temporary)and other complications were analyzed.Results: A total of 27 literatures were included in this study,among which 21 were designed as retrospective case-control studies and 6 were designed as prospective case-control studies,involving 8405 patients,including 3677 patients in the experimental group and 4728 patients in the control group.Patients undergoing prophylactic central lymph node dissection(PCND)with total thyroidectomy had a significantly reduced local recurrence rate compared with patients undergoing total thyroidectomy alone [OR=0.57,95%CI:(0.45,0.71),P<0.00001],while temporary hypoparathyroidism [OR=2.16,95%CI:(1.87,2.48),P<0.00001] and permanent hypoparathyroidism [OR=2.38,95%CI:(1.78,3.18),P<0.00001],temporary recurrent laryngeal nerve injury [OR=1.53,95%CI:(1.21,1.95),P=0.0005]permanent recurrent laryngeal nerve injury [OR=1.62,95%CI:(1.04,2.51),P=0.03]was significantly higher than the control group.However,postoperative hemorrhage[OR=0.97,95%CI:(0.44,2.13),P=0.93],postoperative infection [OR=0.64,95%CI:(0.19,2.15),P=0.47],postoperative chylous leakage [OR=1.22,95%CI:(0.33,4.46),P=0.76],postoperative neck hematoma [OR=1.63,95%CI:(0.88,3.03),P=0.12],no significant difference was shown between groups.Conclusion: In patients with clinically negative lymph nodes(cN0)for papillary thyroid carcinoma,total thyroidectomy plus prophylactic central lymph node dissection(TT+PCND)increases the risk of temporary/permanent parathyroid dysfunction and recurrent laryngeal nerve injury,but significantly reduces the likelihood of postoperative local recurrence.There is no significant disadvantage in postoperative bleeding,infection,chylous leakage,neck hematoma and other complications.All things considered,this study supports the use of PCND,especially in patients with risk factors.