Prophylactic Central Neck Dissection for Papillary Thyroid Carcinoma with Clinically Uninvolved Central Neck Lymph Nodes: A Systematic Review and Meta-analysis
Lawrence Chen
Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA
Search for more papers by this authorYi-Hsiu Wu
Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
Search for more papers by this authorChia-Hwa Lee
School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
Comprehensive Cancer Center of Taipei Medical University, Taipei, Taiwan
Department of Laboratory Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
Search for more papers by this authorHsin-An Chen
Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
Search for more papers by this authorEl-Wui Loh
Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University 291, Zhongzheng Road, Zhonghe District, 23561 New Taipei City, Taiwan
Search for more papers by this authorCorresponding Author
Ka-Wai Tam
- [email protected]
- 886-2-22490088
Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University 291, Zhongzheng Road, Zhonghe District, 23561 New Taipei City, Taiwan
Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
Tel.: 886-2-22490088, [email protected]Search for more papers by this authorLawrence Chen
Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA
Search for more papers by this authorYi-Hsiu Wu
Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
Search for more papers by this authorChia-Hwa Lee
School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
Comprehensive Cancer Center of Taipei Medical University, Taipei, Taiwan
Department of Laboratory Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
Search for more papers by this authorHsin-An Chen
Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
Search for more papers by this authorEl-Wui Loh
Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University 291, Zhongzheng Road, Zhonghe District, 23561 New Taipei City, Taiwan
Search for more papers by this authorCorresponding Author
Ka-Wai Tam
- [email protected]
- 886-2-22490088
Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University 291, Zhongzheng Road, Zhonghe District, 23561 New Taipei City, Taiwan
Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
Tel.: 886-2-22490088, [email protected]Search for more papers by this authorLawrence Chen and Yi-Hsiu Wu have contributed equally to this work.
Abstract
Background
Central neck dissection and total thyroidectomy are standard treatments for patients with papillary thyroid carcinoma (PTC) with clinically involved central nodes. However, prophylactic central neck dissection (pCND) in patients with clinically uninvolved cN0 has been beneficial in some studies but ineffective in others. We conducted a meta-analysis to evaluate the efficacy and safety of pCND in patients with central neck lymph nodes cN0 PTC.
Methods
The PubMed, EMBASE, Cochrane Library, and Scopus databases and the ClinicalTrials.gov registry were electronically searched for studies published until September 2017. The meta-analysis was conducted to calculate the pooled effect size by using random-effects model. Treatment efficacies were measured by determining locoregional recurrence (LRR). Secondary outcomes included transient recurrent laryngeal nerve (RLN) injury, permanent RLN injury, transient hypocalcemia, and permanent hypocalcemia.
Results
Twenty-three retrospective and prospective cohort studies involving 18,376 patients were reviewed. Patients who underwent pCND had significantly lower LRR (odds ratio [OR] 0.65; 95% confidence interval [CI] 0.48–0.88) but significantly higher incidence rates of transient RLN injury (OR 2.03; 95% CI 1.32–3.13), transient hypocalcemia (OR 2.23; 95% CI 1.84–2.70), and permanent hypocalcemia (OR 2.22; 95% CI 1.58–3.13) than that of no pCND group.
Conclusion
Compared with no pCND, pCND significantly reduces LRR but is accompanied by numerous adverse effects. The clinical decision should be made after the shared decision-making process of clinicians and patients.
References
- 1SiegelRL, MillerKD, JemalA Cancer statistics, 2016. CA Cancer J Clin (2016) 66: 7–3010.3322/caac.2133226742998
- 2LangBH, LoCY, ChanWF et al. Prognostic factors in papillary and follicular thyroid carcinoma: their implications for cancer staging. Ann Surg Oncol (2007) 14: 730–73810.1245/s10434-006-9207-517103065
- 3LeboulleuxS, RubinoC, BaudinE et al. Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and/or tumor extension beyond the thyroid capsule at initial diagnosis. J Clin Endocrinol Metab (2005) 90: 5723–572910.1210/jc.2005-028516030160
- 4MooTA, McGillJ, AllendorfJ et al. Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma. World J Surg (2010) 34: 1187–119110.1007/s00268-010-0418-320130868
- 5PopadichA, LevinO, LeeJC et al. A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN0 papillary thyroid cancer. Surgery (2011) 150: 1048–105710.1016/j.surg.2011.09.00322136820
- 6MazzaferriEL, JhiangSM Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med (1994) 97: 418–42810.1016/0002-9343(94)90321-27977430
- 7LundgrenCI, HallP, DickmanPW et al. Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case-control study. Cancer (2006) 106: 524–53110.1002/cncr.2165316369995
- 8MullaM, SchulteKM Central cervical lymph node metastases in papillary thyroid cancer: a systematic review of imaging-guided and prophylactic removal of the central compartment. Clin Endocrinol (Oxf) (2012) 76: 131–13610.1111/j.1365-2265.2011.04162.x
- 9BarczyńskiM, KonturekA, StopaM et al. Prophylactic central neck dissection for papillary thyroid cancer. Br J Surg (2013) 100: 410–41810.1002/bjs.898523188784
- 10CalòPG, PisanoG, MedasF 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: 15210.1186/1477-7819-12-15224885654
- 11Ywata de CarvalhoA, ChulamTC, KowalskiLP Long-term results of observation vs prophylactic selective level VI neck dissection for papillary thyroid carcinoma at a cancer center. JAMA Otolaryngol Head Neck Surg (2015) 141: 599–60610.1001/jamaoto.2015.078625997016
- 12HaugenBR 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: what is new and what has changed?. Cancer (2017) 123: 372–38110.1002/cncr.3036027741354
- 13HuangTW, LaiJH, WuMY et al. Systematic review of clinical practice guidelines in the diagnosis and management of thyroid nodules and cancer. BMC Med (2013) 11: 19110.1186/1741-7015-11-19123987922
- 14ZhaoW, YouL, HouX et al. The effect of prophylactic central neck dissection on locoregional recurrence in papillary thyroid cancer after total thyroidectomy: a systematic review and meta-analysis: pCND for the locoregional recurrence of papillary thyroid cancer. Ann Surg Oncol (2017) 24: 2189–219810.1245/s10434-016-5691-427913945
- 15LiangJ, LiZ, FangF et al. Is prophylactic central neck dissection necessary for cN0 differentiated thyroid cancer patients at initial treatment? A meta-analysis of the literature. Acta Otorhinolaryngol Ital (2017) 37: 1–828374865
- 16SterneJA, HernánMA, ReevesBC et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ (2016) 355: i491910.1136/bmj.i491927733354
- 17ChoiSJ, KimTY, LeeJC et al. Is routine central neck dissection necessary for the treatment of papillary thyroid microcarcinoma?. Clin Exp Otorhinolaryngol (2008) 1: 41–4510.3342/ceo.2008.1.1.4119434261
- 18CalòPG, LombardiCP, PoddaF et al. Role of prophylactic central neck dissection in clinically node-negative differentiated thyroid cancer: assessment of the risk of regional recurrence. Updates Surg (2017) 69: 241–24810.1007/s13304-017-0438-828409443
- 19LiberatiA, AltmanDG, TetzlaffJ et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol (2009) 62: e1–e3410.1016/j.jclinepi.2009.06.00619631507
- 20DerSimonianR, LairdN Meta-analysis in clinical trials. Control Clin Trials (1986) 7: 177–18810.1016/0197-2456(86)90046-23802833
- 21CostaS, GiuglianoG, SantoroL et al. Role of prophylactic central neck dissection in cN0 papillary thyroid cancer. Acta Otorhinolaryngol Ital (2009) 29: 61–6920111614
- 22DobrinjaC, TroianM, Cipolat MisT et al. Rationality in prophylactic central neck dissection in clinically node-negative (cN0) papillary thyroid carcinoma: is there anything more to say? A decade experience in a single-center. Int J Surg (2017) 41(Suppl 1): S40–S4710.1016/j.ijsu.2017.01.11328506412
- 23GiordanoD, ValcaviR, ThompsonGB et al. Complications of central neck dissection in patients with papillary thyroid carcinoma: results of a study on 1087 patients and review of the literature. Thyroid (2012) 22: 911–91710.1089/thy.2012.001122827494
- 24HughesDT, WhiteML, MillerBS et al. Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer. Surgery (2010) 148: 1100–110610.1016/j.surg.2010.09.01921134539
- 25HyunSM, SongHY, KimSY et al. Impact of combined prophylactic unilateral central neck dissection and hemithyroidectomy in patients with papillary thyroid microcarcinoma. Ann Surg Oncol (2012) 19: 591–59610.1245/s10434-011-1995-621837525
- 26KorkmazMH, ÖcalB, SaylamG et al. The need of prophylactic central lymph node dissection is controversial in terms of postoperative thyroglobulin follow-up of patients with cN0 papillary thyroid cancer. Langenbecks Arch Surg (2017) 402: 235–24210.1007/s00423-017-1556-y28224278
- 27KimSK, WooJW, LeeJH et al. Prophylactic central neck dissection might not be necessary in papillary thyroid carcinoma: analysis of 11,569 cases from a single institution. J Am Coll Surg (2016) 222: 853–86410.1016/j.jamcollsurg.2016.02.00127113516
- 28LangBH, WongKP, WanKY 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: 60–6710.1245/s10434-011-1833-x21681379
- 29LeeDY, OhKH, ChoJG et al. The benefits and risks of prophylactic central neck dissection for papillary thyroid carcinoma: prospective cohort study. Int J Endocrinol (2015) 2015: 57148026246805
- 30PalestiniN, BorasiA, CestinoL et al. Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience. Langenbecks Arch Surg (2008) 393: 693–69810.1007/s00423-008-0360-018592264
- 31RaffaelliM, De CreaC, SessaL 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: 957–96410.1016/j.surg.2012.08.05323158170
- 32SoYK, SeoMY, SonYI 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: 192–19810.1016/j.surg.2011.02.00421497873
- 33SywakM, CornfordL, RoachP et al. Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery (2006) 140: 1000–100510.1016/j.surg.2006.08.00117188149
- 34ViolaD, MaterazziG, ValerioL et al. Prophylactic central compartment lymph node dissection in papillary thyroid carcinoma: clinical implications derived from the first prospective randomized controlled single institution study. J Clin Endocrinol Metab (2015) 100: 1316–132410.1210/jc.2014-382525590215
- 35ZhangL, LiuZ, LiuY et al. The clinical prognosis of patients with cN0 papillary thyroid microcarcinoma by central neck dissection. World J Surg Oncol (2015) 13: 13810.1186/s12957-015-0553-225889385
- 36ZunigaS, SanabriaA Prophylactic central neck dissection in stage N0 papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg (2009) 135: 1087–109110.1001/archoto.2009.16319917919
- 37Marin ArteagaA, PeloniG, LeuchterI et al. Modification of the surgical strategy for the dissection of the recurrent laryngeal nerve using continuous intraoperative nerve monitoring. World J Surg (2017) 10.1007/s00268-017-4277-z
