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Updated: Oct 4, 2025
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Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
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Prophylactic Central Neck Lymph Node Dissection in Low-risk Thyroid Carcinoma Patients Does Not Decrease the
Alvaro Sanabria1,2,3,4,5, Carlos Betancourt-Agüero1,3,4,5, Juan G Sánchez-Delgado1,2,3,4,5
1Department of Surgery, School of Medicine, Universidad de Antioquia, Medellín, Colombia.
Annals of Surgery
|February 7, 2022
Summary
Prophylactic central neck dissection (CND) with thyroidectomy (T) did not reduce recurrence in papillary thyroid cancer (PTC) patients. However, it increased the risk of permanent hypoparathyroidism.
Area of Science:
- Endocrinology
- Surgical Oncology
- Clinical Trials
Background:
- Limited randomized controlled trials (RCTs) exist for prophylactic central neck dissection (CND) in papillary thyroid cancer (PTC).
- Existing recommendations often rely on meta-analyses including observational studies prone to bias.
Purpose of the Study:
- To evaluate the effectiveness of thyroidectomy plus prophylactic CND (T+CND) versus thyroidectomy alone (T) for locoregional recurrence in PTC patients.
- To assess recurrence rates and complications associated with prophylactic CND.
Main Methods:
- Systematic review and meta-analysis of RCTs comparing T versus T+CND in adult cN0 PTC patients.
- Outcomes included structural and biochemical recurrence, and complications.
- Methodological quality assessed using the Revised Cochrane risk-of-bias tool; robustness evaluated with the fragility index.
Main Results:
- Five RCTs (763 patients) were analyzed; most had low risk of bias, with no publication bias found.
- Structural recurrence: 2.7% (T+CND) vs. 2.5% (T) (RD 0%, 95% CI -2% to 2%).
- Biochemical recurrence: RD 0% (95% CI -5% to 4%). Permanent hypoparathyroidism: higher in T+CND group (RD 3%, 95% CI 0%-6%).
Conclusions:
- Prophylactic CND with thyroidectomy offers no significant benefit in reducing locoregional or biochemical recurrence for PTC.
- Prophylactic CND is associated with an increased risk of permanent hypoparathyroidism.
