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

BackgroundProphylactic central neck dissection (CND) at the time of total thyroidectomy (TT) remains controversial in clinically node-negative (cN0) papillary thyroid carcinoma (PTC). This systematic review and meta-analysis was performed to compare the local recurrence between patients who underwent TT plus CND and those who underwent TT alone.MethodsThe publicly available literature published from January 1990 to October 2017 concerning TT plus prophylactic CND versus TT for PTC was retrieved by searching the national and international online databases. Meta-analysis was performed after the data extraction process.ResultsTwenty-five studies with comparison between TT + CND and TT alone were eligible and included in this meta-analysis. For both PTC and papillary thyroid microcarcinoma (PTMC), the overall recurrence in TT + CND group was significantly lower than that in TT alone group. The central compartment recurrence was significantly higher in TT alone group than TT + CND group (OR = 3.41, 95% Cl [2.00 ～ 5.80], P < 0.00001), while no significant difference of lateral compartment recurrence was observed between the two groups (OR = 1.19, 95%Cl [0.81 ～ 1.77], P = 0.38). We compared ipsilateral CND + TT with TT alone and found that the recurrence was not significantly different between the two groups (OR = 1.44, 95%Cl [0.74 ～ 2.81], P = 0.28). On the other hand, bilateral CND + TT showed significantly low recurrence (OR = 2.48, 95%Cl [1.75 ～ 3.53], P < 0.00001).ConclusionsThe addition of CND to TT resulted in a greater reduction in risk of local recurrence than TT alone, especially preventing central neck recurrences. Additionally, we discovered that bilateral CND in patients with PTC > 1 cm was necessary.