Prophylactic Central Neck Dissection Versus Traditional Total Thyroidectomy for Stage cN0 Papillary Thyroid Carcinoma: A Meta-Analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 ZHANGLei , WANGYang , LIXin-xi , TIANYe , BAIChao ,  LUOJun.

Department of Vascular and Thyroid Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Xinjiang Uygur Autonomous Region, China;

Corresponding author：

LUOJun., Email: xmuluo@163.com

Keywords：

Prophylactic central neck dissection; Total thyroidectomy; Stage cN0 papillary thyroid carcinoma; Effectiveness; Safety; Systematic review; Meta-analysis

DOI：

10.7507/1007-9424.20150387

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Objective To systematically evaluate effectiveness and safety of total thyroidectomy(TT) plus prophylactic central neck dissection(PCND) versus TT for stage cN0 papillary thyroid carcinoma(PTC). Methods Databases including PubMed, EMbase, The Cochrane Library(Issue1, 2015), WanFang Data, CBM, and CNKI were searched to collect the randomized controlled trails(RCTs) and non-RCTs about TT+PCND versus TT for stage cN0 PTC. The retrieval time was from inception to March 2015. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated independently by 2 reviewers. Then the meta-analysis was conducted using RevMan 5.1 software. Results A total of 10 non-RCTs involving 3 661 patients were included. There were 1 774 cases in the TT+PCND group and 1 887 cases in the TT group. The results of meta-analysis showed that: Related to postoperative complications, compared with TT group, the postoperative transient hypocalcemia rate〔OR=0.40, 95% CI(0.33, 0.49), P < 0.000 01〕and permanent hypocalcemia rate were higher〔OR=0.32, 95% CI(0.19, 0.55), P < 0.000 1〕, the recurrence rate was lower〔OR=1.51, 95% CI(1.07, 2.13), P=0.02〕in the TT+PCND group. But there were no differences in the transient laryngeal nerve palsy rate〔OR=0.73, 95% CI(0.49, 1.09), P=0.13〕and permanent laryngeal nerve palsy rate〔OR=0.87, 95% CI(0.50, 1.52), P=0.62〕between the 2 groups. Conclusions TT+PCND is superior to TT in treating stage cN0 PTC for it's lower recurrence, but it is raising transient hypocalcemia and permanent hypocalcemia rate at the same time. And it is similar as TT in transient laryngeal nerve palsy and permanent laryngeal nerve palsy rate. So TT+PCND is safe and feasible for treating stage cN0 PTC when its indications are strictly controlled. However, for the quantity and quality limitation of the included studies, this conclusion still requires to be further proved by performing large scale and high quality RCTs. It suggests that doctors should choose a best therapy for stage cN0 PTC patients according to an integrative disease assessment.

Citation： ZHANGLei, WANGYang, LIXin-xi, TIANYe, BAIChao, LUOJun.. Prophylactic Central Neck Dissection Versus Traditional Total Thyroidectomy for Stage cN0 Papillary Thyroid Carcinoma: A Meta-Analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2015, 22(12): 1487-1493. doi: 10.7507/1007-9424.20150387 Copy

1.	Fritze D, Doherty GM. Surgical management of cervical lymph nodes in differentiated thyroid cancer. Otolaryngol Clin North Am, 2010, 43(2): 285-300, viii.
2.	Iyer NG, Shaha AR. Central compartment dissection for well differentiated thyroid cancer and the band plays on. Curr Opin Otolaryngol Head Neck Surg, 2011, 19(2): 106-112.
3.	Sobin LH, Gospodarowicz MK, Wittenkind C.恶性肿瘤TNM分期.第7版.天津:天津科技出版公司, 2012: 57-62.
4.	Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale(NOS) for assessing the quality if nonrandomized studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.
5.	Roh JL, Park JY, Park CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg, 2007, 245(4): 604-610.
6.	Shen WT, Ogawa L, Ruan D, et al. Central neck lymph node dissection for papillary thyroid cancer: the reliability of surgeon judgment in predicting which patients will benefit. Surgery, 2010, 148(2): 398-403.
7.	Popadich A, Levin O, Lee JC, et al. A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN0 papillary thyroid cancer. Surgery, 2011, 150(6): 1048-1057.
8.	Lang BH, Wong KP, Wan KY, et al. Impact of routine unilateral central neck dissection on preablative and postablative stimulated thyroglobulin levels after total thyroidectomy in papillary thyroid carcinoma. Ann Surg Oncol, 2012, 19(1): 60-67.
9.	Raffaelli M, De Crea C, Sessa L, et al. Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node-negative papillary thyroid carcinoma. Surgery, 2012, 152(6): 957-964.
10.	So YK, Seo MY, Son YI. Prophylactic central lymph node dissection for clinically node-negative papillary thyroid microcarcinoma: influence on serum thyroglobulin level, recurrence rate, and postoperative complications. Surgery, 2012, 151(2): 192-198.
11.	Barczyński M, Konturek A, Stopa M, et al. Prophylactic central neck dissection for papillary thyroid cancer. Br J Surg, 2013, 100(3): 410-418.
12.	Calò PG, Pisano G, Medas F, et al. Total thyroidectomy without prophylactic central neck dissection in clinically node-negative papillary thyroid cancer: is it an adequate treatment? World J Surg Oncol, 2014, 12: 152.
13.	Conzo G, Calò PG, Sinisi AA, et al. Impact of prophylactic central compartment neck dissection on locoregional recurrence of differe-ntiated thyroid cancer in clinically node-negative patients: a retrospective study of a large clinical series. Surgery, 2014, 155(6): 998-1005.
14.	Zhang L, Liu Z, Liu Y, et al. The clinical prognosis of patients with cN0 papillary thyroid microcarcinoma by central neck dissection. World J Surg Oncol, 2015, 13(1): 138.
15.	Cancer Genome Atlas Research Network. Integrated genomic characterization of papillary thyroid carcinoma. Cell, 2014, 159(3): 676-690.
16.	孙团起, 吴毅.领式切口保留颈丛择区性颈部淋巴结清扫术治疗分化型甲状腺癌112例分析.中国实用外科杂志, 2011, 31(5): 411-413.
17.	Hughes CJ, Shaha AR, Shah JP, et al. Impact of lymph node metastasis in differentiated carcinoma of the thyroid: a matched-pair analysis. Head Neck, 1996, 18(2): 127-132.
18.	Henry JF, Gramatica L, Denizot A, et al. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg, 1998, 383(2): 167-169.
19.	Sywak M, Cornford L, Roach P, et al. Routine ipsilateral levelⅥlymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery, 2006, 140(6): 1000-1007.
20.	中华医学会内分泌学分会.甲状腺结节和分化型甲状腺癌诊治指南.中国肿瘤临床, 2012, 33(17): 1249-1272.
21.	康德英, 洪旗, 刘关键, 等. Meta分析中发表性偏倚的识别与处理.中国循证医学杂志, 2003, 3(1): 45-49.

1. Fritze D, Doherty GM. Surgical management of cervical lymph nodes in differentiated thyroid cancer. Otolaryngol Clin North Am, 2010, 43(2): 285-300, viii.
2. Iyer NG, Shaha AR. Central compartment dissection for well differentiated thyroid cancer and the band plays on. Curr Opin Otolaryngol Head Neck Surg, 2011, 19(2): 106-112.
3. Sobin LH, Gospodarowicz MK, Wittenkind C.恶性肿瘤TNM分期.第7版.天津:天津科技出版公司, 2012: 57-62.
4. Wells GA, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale(NOS) for assessing the quality if nonrandomized studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm.
5. Roh JL, Park JY, Park CI. Total thyroidectomy plus neck dissection in differentiated papillary thyroid carcinoma patients: pattern of nodal metastasis, morbidity, recurrence, and postoperative levels of serum parathyroid hormone. Ann Surg, 2007, 245(4): 604-610.
6. Shen WT, Ogawa L, Ruan D, et al. Central neck lymph node dissection for papillary thyroid cancer: the reliability of surgeon judgment in predicting which patients will benefit. Surgery, 2010, 148(2): 398-403.
7. Popadich A, Levin O, Lee JC, et al. A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN0 papillary thyroid cancer. Surgery, 2011, 150(6): 1048-1057.
8. Lang BH, Wong KP, Wan KY, et al. Impact of routine unilateral central neck dissection on preablative and postablative stimulated thyroglobulin levels after total thyroidectomy in papillary thyroid carcinoma. Ann Surg Oncol, 2012, 19(1): 60-67.
9. Raffaelli M, De Crea C, Sessa L, et al. Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node-negative papillary thyroid carcinoma. Surgery, 2012, 152(6): 957-964.
10. So YK, Seo MY, Son YI. Prophylactic central lymph node dissection for clinically node-negative papillary thyroid microcarcinoma: influence on serum thyroglobulin level, recurrence rate, and postoperative complications. Surgery, 2012, 151(2): 192-198.
11. Barczyński M, Konturek A, Stopa M, et al. Prophylactic central neck dissection for papillary thyroid cancer. Br J Surg, 2013, 100(3): 410-418.
12. Calò PG, Pisano G, Medas F, et al. Total thyroidectomy without prophylactic central neck dissection in clinically node-negative papillary thyroid cancer: is it an adequate treatment? World J Surg Oncol, 2014, 12: 152.
13. Conzo G, Calò PG, Sinisi AA, et al. Impact of prophylactic central compartment neck dissection on locoregional recurrence of differe-ntiated thyroid cancer in clinically node-negative patients: a retrospective study of a large clinical series. Surgery, 2014, 155(6): 998-1005.
14. Zhang L, Liu Z, Liu Y, et al. The clinical prognosis of patients with cN0 papillary thyroid microcarcinoma by central neck dissection. World J Surg Oncol, 2015, 13(1): 138.
15. Cancer Genome Atlas Research Network. Integrated genomic characterization of papillary thyroid carcinoma. Cell, 2014, 159(3): 676-690.
16. 孙团起, 吴毅.领式切口保留颈丛择区性颈部淋巴结清扫术治疗分化型甲状腺癌112例分析.中国实用外科杂志, 2011, 31(5): 411-413.
17. Hughes CJ, Shaha AR, Shah JP, et al. Impact of lymph node metastasis in differentiated carcinoma of the thyroid: a matched-pair analysis. Head Neck, 1996, 18(2): 127-132.
18. Henry JF, Gramatica L, Denizot A, et al. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg, 1998, 383(2): 167-169.
19. Sywak M, Cornford L, Roach P, et al. Routine ipsilateral levelⅥlymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery, 2006, 140(6): 1000-1007.
20. 中华医学会内分泌学分会.甲状腺结节和分化型甲状腺癌诊治指南.中国肿瘤临床, 2012, 33(17): 1249-1272.
21. 康德英, 洪旗, 刘关键, 等. Meta分析中发表性偏倚的识别与处理.中国循证医学杂志, 2003, 3(1): 45-49.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Prophylactic Central Neck Dissection Versus Traditional Total Thyroidectomy for Stage cN0 Papillary Thyroid Carcinoma: A Meta-Analysis

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