Prophylactic Central Neck Dissection Withl Thyroidectomy For CN0 Papillary Thyroid Carcinoma

Objective:Central neck dissection and total thyroidectomy are standard treatments for patients with papillary thyroid carcinoma(PTC)with clinically involved central nodes.Central lymph node metastasis is common in papillary thyroid carcinoma(PTC).However,prophylactic central neck dissection(pCND)in patients with clinically uninvolved cN0 is still controversial.The aim of this meta-analysis is to examine the pros and cons of prophylactic neck dissection in cN0 PTC.Methods:A systematic literature search was performed using PubMed,EMBASE,Cochrane Library and Web of Science,until September 2018.The meta-analysis was conducted to calculate the pooled effect size by using random-effects model.Locoregional recurrence(LRR)and surgical complications were analyzed.,included temporary recurrent laryngeal nerve(LNR)injury,permanent LNR injury,temporary hypoparathyroidism,and permanent hypoparathyroidism.Results: Twelve studies comparing pCND + TT(combined)and TT alone in cN0 PTC patients were analyzed.A total of 3495 cases were involved.Patients who underwent pCND had significantly lower LRR(OR 0.56;95% CI 0.33–0.96).However,the pCND+ TT group showed a significantly higher rate of temporary hypocalcemia(OR 2.15;95%CI 1.69–2.73),permanent hypocalcemia(OR 3.53;95% CI 2.24–5.57)and temporary recurrent laryngeal nerve injury(LNR)(OR 1.17;95% CI 1.25–2.49).There was no statistical difference in the rate of permanent LNR.Conclusion:Compared with TT alone,pCND+TT significantly reduces LRR but is accompanied by numerous postoperative complications.pCND+TT increased the incidence rate of temporary and permanent hypoparathyroidism and temporary LNR.The clinical decision should be made after the shared decision-making process of clinicians and patients.