The Clinical Efficacy And Safety Of Prophylactic Central Neck Dissection On Papillary Thyroid Carcinoma In Stage CN0:A Meta-analysis

Objective: To systematically evaluate the clinical efficacy and safety of prophylactic central neck dissection in patients with stage cN0 papillary thyroid carcinoma,and to provide more evidence to determine whether patients with stage cN0 papillary thyroid carcinoma should undergo prophylactic central neck dissection.Methods: The Web of Science,EMBASE,Pub Med,Springer,CNKI were systematically searched for all the studies between January 2010 and January 2020 that concerned prophylactic central neck dissection in patients with stage cN0 papillary thyroid carcinoma.Literature was independently searched,screened and quality evaluated by two researchers according to the inclusion and exclusion criteria.The relevant data were extracted from the studies that met the requirements.Then use Rev Man 5.3 to perform statistical analysis in order to obtain the final results.Result: A total of 7 retrospective cohort studies published between January 2010 to January 2020 were included in this meta-analysis,involving 12833 patients,of which 9285 patients underwent thyroidectomy + prophylactic central neck dissection,and 3548 patients were only performed with thyroidectomy.Meta-analysis shows that patients who underwent thyroidectomy + prophylactic central neck dissection had a significantly lower local recurrence rate after surgery [OR=0.69,95%CI:(0.55,0.87),p=0.002],but temporarily RLN injury[OR=3.88,95%CI :(2.34,6.43),p<0.00001],temporarily hypoparathyroidism[OR=2.22,95%CI:(1.88,2.62),p<0.00001],permanent hypoparathyroidism[OR=2.67,95%CI:(1.67,4.25),p<0.00001] are significantly higher than those of the group who underdoing thyroidectomy alone,while permanent RLN injury[OR=2.95,95%CI:(0.79,11.09),p=0.11] showed no significant difference.Conclusion: In the clinical treatment of stage cN0 papillary thyroid carcinoma,thyroidectomy + prophylactic central neck dissection can reduce the local recurrence rate of patients compared with the groups who only underwent thyroidectomy,but it increases the risk of temporarily RLN injury,temporarily hypoparathyroidism and permanent hypoparathyroidism,but there is no significant difference between the two in terms of permanent RLN injury.