Prophylactic central neck dissection and local recurrence in papillary thyroid microcarcinoma: a meta-analysis

Su, Hui; Li, Yujie

doi:10.1016/j.bjorl.2018.05.004

Cited by 28 publications

(45 citation statements)

References 29 publications

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“…The most frequently reported surgeryrelated aftermaths included hypoparathyroidism, hypocalcemia, and recurrent laryngeal nerve injury. [9][10][11][12] To date, it remains unclearly determined if TT plus pCND offers greater oncological benefits without concurrently heightening the risk of postsurgical adverse events among cN0 PTC patients. 6 Indeed, potential reasons for this controversy of pCND include meta-analysis evidence derived largely from low-quality retrospective-based studies, [9][10][11][12] recommendations merely grounded on expert opinions, 5 and lack of adequate randomized and prospective controlled studies.…”

Section: Introductionmentioning

confidence: 99%

Prophylactic Central Neck Dissection for Clinically Node‐Negative Papillary Thyroid Carcinoma

Alsubaie

Alzahrani

et al. 2021

The Laryngoscope

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Objective: We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) that scrutinized the oncological benefits and postsurgical complications of total thyroidectomy (TT) plus prophylactic central neck dissection (pCND) versus TT alone among clinically node-negative (cN0) papillary thyroid cancer (PTC) patients.Methods: We screened five databases from inception to September 4, 2021 and evaluated the risk of bias of the eligible studies. We pooled dichotomous outcomes using the risk ratio (RR) with 95% confidence interval (CI).Results: Overall, we included 5 RCTs with low risk of bias comprising 795 patients (TT plus pCND = 410 and TT alone = 385). With regard to efficacy endpoint, the rate of structural loco-regional recurrence did not significantly differ between both groups (n = 4 RCTs, RR = 0.49, 95% CI [0.19, 1.27], P = .14). With regard to safety endpoints, the rates of hypoparathyroidism (n = 5 RCTs, RR = 1.48, 95% CI [0.73, 2.97], P = .27), recurrent laryngeal nerve injury (n = 5 RCTs, RR = 1.34, 95% CI [0.59, 3.03], P = .48), and bleeding (n = 3 RCTs, RR = 1.75, 95% CI [0.42, 7.26], P = .44) did not significantly differ between both groups.Conclusion: For cN0 PTC patients, there was no significant difference between TT plus pCND and TT alone with regard to the rate of structural loco-regional recurrence or frequency of postsurgical complications. Adaptation of pCND in cN0 PTC patients should be contemplated by taking into consideration the clinical oncological benefits and rate of postsurgical adverse events.

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Section: Introductionmentioning

confidence: 99%

Prophylactic Central Neck Dissection for Clinically Node‐Negative Papillary Thyroid Carcinoma

Alsubaie

Alzahrani

et al. 2021

The Laryngoscope

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“…Furthermore, performing a prophylactic central dissection in a center with a large flow of patients, in selected cases such as those studied in our series, is not associated with an increased risk of complications. Several recent meta-analyses underline how it is associated with a lower number of local relapses [ 63 , 64 ]. However, this position remains contested; some authors report the importance of different approaches, such as radioactive iodine ablation, in low-risk cases and cite insufficient evidence for routinely performing central neck dissection to improve patients’ prognosis [ 65 , 66 ].…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Central Compartment Lymph Node Metastases in Papillary Thyroid Micro-Carcinoma: A Retrospective Evaluation of Predictive Preoperative Features

Tagliabue

Giugliano

Mariani

et al. 2021

Cancers

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Papillary thyroid micro-carcinomas are considered relatively indolent carcinomas, often occult and incidental, with good prognosis and favorable outcomes. Despite these findings, central lymph node metastases are common, and are related to a poor prognosis for the patient. We performed a retrospective analysis on patients treated with surgery for stage pT1a papillary thyroid micro-carcinomas. One hundred ninety-five patients were included in the analyses. The presence of central lymph node metastases was identified and studied. A multivariate analysis employing binary logistic regression was used to calculate adjusted odds ratios with 95% confidence intervals of possible central lymph node metastases risk factors. In the performed multivariate analysis, male gender, younger age, and histopathological characteristics, such as a tumor sub-capsular localization, were significantly associated with central lymph node metastases in pT1a patients. Central compartment lymph node metastases are present in a non-negligible number of cases in patients with papillary thyroid micro-carcinoma undergoing surgical resection. Studying these factors could be an effective tool for predicting patients’ central lymph node metastases in papillary thyroid micro-carcinomas, defining a tailored surgical treatment in the future.

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“…In a large meta-analysis of over 1200 patients, Zetoune et al reported benefit of neither loco-regional control nor overall survival with a prophylactic central neck dissection in patients with PTC [53]. Up-to-date, there are several systematic reviews with contradictory results on the role of prophylactic CND due to differences in inclusion criteria, size of the tumor, and heterogeneity in the interventions [50,[54][55][56][57][58][59]. As there is a lack of evidence to support any benefit from prophylactic central neck dissection in low-risk patient groups, the concept of aggressive neck surgery to upstage and facilitate RAI seems illogical.…”

Section: Opponents Of Prophylactic/elective Cndmentioning

confidence: 99%

Management of the Neck in Well-Differentiated Thyroid Cancer

et al. 2020

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Purpose of Review In this narrative review, we discuss the indications for elective and therapeutic neck dissections and the postoperative surveillance and treatment options for recurrent nodal disease in patients with well-differentiated thyroid cancer. Recent Findings Increased availability of advanced imaging modalities has led to an increased detection rate of previously occult nodal disease in thyroid cancer. Nodal metastases are more common in young patients, large primary tumors, specific genotypes, and certain histological types. While clinically evident nodal disease in the lateral neck compartments has a significant oncological impact, particularly in the older age group, microscopic metastases to the central or the lateral neck in well-differentiated thyroid cancer do not significantly affect outcome. Summary As patients with clinically evident nodal disease are associated with worse outcomes, they should be treated surgically in order to reduce rates of regional recurrence and improve survival. The benefit of elective neck dissection remains unverified as the impact of microscopic disease on outcomes is not significant. Keywords Lymphatic metastasis . Neck dissection . Thyroid neoplasmsThis article is part of the Topical Collection on Head and Neck Cancers This article was written by members and invitees of the International Head and Neck Scientific Group (www.IHNSG.com).

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Prophylactic central neck dissection and local recurrence in papillary thyroid microcarcinoma: a meta-analysis

Abstract: For patients with papillary thyroid microcarcinoma, thyroidectomy plus prophylactic central neck dissection is a safe and efficient procedure and it results in lower recurrence rate. Since the evidences are of low quality (non-randomized studies), further randomized trials are needed.

Cited by 28 publications

References 29 publications

Prophylactic Central Neck Dissection for Clinically Node‐Negative Papillary Thyroid Carcinoma

Prophylactic Central Neck Dissection for Clinically Node‐Negative Papillary Thyroid Carcinoma

Prevalence of Central Compartment Lymph Node Metastases in Papillary Thyroid Micro-Carcinoma: A Retrospective Evaluation of Predictive Preoperative Features

Management of the Neck in Well-Differentiated Thyroid Cancer

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