The Effect of Prophylactic Central Neck Dissection during Total Thyroidectomy on Locoregional Recurrence in Patients with Papillary Thyroid Carcinoma: An Updated Meta-Analysis

Abstract

AIM: The current systematic review was conducted to update the existing evidence regarding the association between prophylactic central neck dissection (pCND) and locoregional recurrence (LRR) in patients undergoing total thyroidectomy (TT). METHODS: Studies were identified through systematic searches of electronic databases (PubMed, Scopus, Cochrane Library, and Clinical Trials.gov) between November and December 2022. The primary outcome was the unadjusted pooled estimate for LRR using an inverse variance – a weighted random-effects meta-analysis of odds ratios (ORs). RESULTS: Twenty-two studies comparing pCND + TT and TT alone in cN0 PTC patients were analyzed. The meta- analysis included 6918 patients,  2796 cases in the combined group, and 3402 controls in the TT-alone group. The summary OR for overall LRR was not statistically significant, indicating a lack of additional benefit for pCND (OR = 0.76 95% CI [0.5–1.14], p = 0.18). Results were consistent for studies with an experimental or nonexperimental design. The rates of transient (OR = 1.81, 95% CI [1.36–2.41], p < 0.001) and permanent (OR = 2.56, 95% CI [1.72–3.8], p < 0.001) hypoparathyroidism were significantly higher in patients who underwent pCND. The rates of transient (OR = 1.71, 95% CI 1.24–2.35, p < 0.001) and permanent (OR = 2.12, 95% CI 1.29–3.45, p < 0.001) RLN nerve injury were also higher in patients who underwent pCND. Contradictory results were observed for adjuvant RAI with RCTs suggesting a lower need for postoperative RAI therapy. CONCLUSION: The meta-analysis and the systematic review suggest that pCND was not associated with lower odds of LRR in patients with N0 PTC. Moreover, transient and permanent hypoparathyroidism and RLN injury were higher in patients undergoing TT + PCND. TT + pCND should not be routinely recommended except in high-risk patients due to the lack of benefit and lower safety profile than TT only.