The Effect Of Prophylactic Central Neck Dissection On Papillary Thyroid Carcinoma In CN0 Stage:A Meta Analysis

Objective:By means of Meta analysis,The difference of the recurrence rate and the main complication rate of papillary thyroid carcinoma(PTC)in the cN0 stage was compared with That of The primary tumor resection(T)and the central cervical lymph node resection(T+PCND).To evaluate the safety and effectiveness of PCND and provide evidence basis for standardized treatment of PTC.Methods:PubMed,EMbase,CNKI,Wanfang database,The Cochrane Library and The Chinese biomedical literature database were used to search the literature published between 2007 and 2017 on The primary thyroid cancer,and to screen and evaluate The quality of the literature by formulating the inclusion criteria and exclusion criteria.Finally,the eligible documents were selected,and the data of the relevant evaluation indexes were extracted.The Meta-analysis was carried out by RevMan5.3 software.The Two-component variable data was expressed by OR and 95% confidence interval(95% CI),and the local recurrence rate,postoperative temporary hypocalcemia,postoperative permanent hypocalcemia,postoperative temporary recurrent laryngeal nerve injury and postoperative permanent recurrent laryngeal nerve injury were used to compare and evaluate the risks and benefits of PCND.Results:After literature screening,10 articles were selected,all of which were rertospective cohort study.A total of 3383 subjects were enrolled,including 1586 cases in primary tumor resection + preventive central cervical lymph node dissection group(T+PCND)and1797 cases in primary tumor resection group(T).Meta-analysis showed that:(1)The local recurrence rate comparison: a total of 10 articles were included,and 3383 cases were included in The study.There was no significant difference between T+PCND group(1586 cases)and T group(1797 cases){OR=0.97,95%CI(0.63,1.50),P=0.90}.(2)Comparison of the incidence of transient hypocalcemia after operation: a total of 2529 subjects were included in 8 articles,including1055 cases in T+PCND group and 1474 cases in T group.The incidence of transient hypocalcemia in T+PCND group was higher than that in T group.There was significant difference in the incidence of transient hypocalcemia after operation {OR=2.20,95%CI(1.81,2.68),P<0.00001}.(3)Comparison of the incidence of permanent hypocalcemia after operation: a total of 3139 cases were included in 9 articles,of which 1460 cases in T+PCND group and 1679 cases in T group.The incidence of permanent hypocalcemia in T+PCND group was higher than that in T group.There was significant difference in the incidence of permanent hypocalcemia after operation {OR=3.02,95%CI(1.97,4.61),P<0.00001}.(4)Comparison of the incidence of transient laryngeal nerve injury after operation: a total of 2529 subjects were included in 8 articles,including 1055 cases in T+PCND group and 1474 cases in T group.The incidence of transient laryngeal nerve injury in T+PCND group was higher than that in T group.There was significant difference in the incidence of transient laryngeal nerve injury after operation {OR=1.58,95%CI(1.06,2.34),P=0.02}.(5)Comparison of the incidence of permanent laryngeal nerve injury after operation: a total of 3139 cases were included in 9 articles,of which 1460 cases in T+PCND group and 1679 cases in T group.The incidence of permanent laryngeal nerve injury in T+PCND group was higher than that in T group.There was significant difference in the incidence of permanent laryngeal nerve injury after operation {OR=1.90,95%CI(1.10,3.58),P=0.05}.Conclusion:(1)There was no significant difference in local recurrence rate between T+PCND group and T group.(2)The incidence of postoperative complications(temporary hypocalcemia,permanent hypocalcemia,temporary recurrent laryngeal nerve injury and permanent recurrent laryngeal nerve injury)in the T+PCND group was significantly higher than that in the T group.