Local lymph node recurrence after central neck dissection in papillary thyroid cancers: A meta analysis.

Area of Science:

• Endocrinology
• Surgical Oncology
• Head and Neck Surgery

Background:

• Prophylactic central neck dissection (CND) during total thyroidectomy (TT) for clinically node-negative (cN0) papillary thyroid carcinoma (PTC) is debated.
• This study compares local recurrence rates between TT with CND and TT alone.

Purpose of the Study:

• To evaluate the efficacy of prophylactic central neck dissection (CND) in reducing local recurrence in papillary thyroid carcinoma (PTC) patients undergoing total thyroidectomy (TT).
• To compare recurrence rates in the central and lateral neck compartments between patients who received TT plus CND versus TT alone.

Main Methods:

• A systematic review and meta-analysis of studies published between January 1990 and October 2017.
• Inclusion criteria focused on comparisons between TT with prophylactic CND and TT alone for PTC.
• Data extraction and meta-analysis were performed on eligible studies.

Main Results:

• Twenty-five studies were included, showing significantly lower overall recurrence with TT plus CND compared to TT alone for both PTC and papillary thyroid microcarcinoma (PTMC).
• Central compartment recurrence was significantly higher in the TT alone group (OR=3.41).
• Bilateral CND with TT demonstrated significantly low recurrence (OR=2.48), while ipsilateral CND showed no significant difference compared to TT alone.

Conclusions:

• Adding CND to TT significantly reduces the risk of local recurrence, particularly in the central neck compartment.
• Bilateral CND is recommended for patients with PTC measuring greater than 1cm to minimize recurrence risk.