Comparison of prophylactic ipsilateral and bilateral central lymph node dissection in papillary thyroid carcinoma: a meta-analysis

Li, Yujie; Lao, Lingling

doi:10.1016/j.bjorl.2023.101318

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Brazilian Journal of Otorhinolaryngology

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Sumário

REVIEW ARTICLE • Braz. j. otorhinolaryngol. 89 (6) • 2023 • https://doi.org/10.1016/j.bjorl.2023.101318 copy

Comparison of prophylactic ipsilateral and bilateral central lymph node dissection in papillary thyroid carcinoma: a meta-analysis^☆ ☆ Peer Review under the responsibility of Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

The scope of surgical resection for paratracheal (level VI) lymph nodes in patients with Papillary Thyroid Carcinoma (PTC) remains debatable. The aim of our study was to evaluate the effectiveness and safety of prophylactic ipsilateral Central Neck lymph node Dissection (CND) versus bilateral CND at the time of total thyroidectomy for Clinically Node-negative (cN0) unilateral PTC.

Methods:

A systematic retrieval of electronic databases, including Pubmed, Web of Science, and the China Journal Net, was conducted from January 1990 to September 2021. Outcome data of interest included transient hypoparathyroidism, permanent hypoparathyroidism, transient Recurrent Laryngeal Nerve (RLN) injury, permanent RLN injury and local recurrence. We constructed the summary Odds Ratios (ORs) and 95% Confidence Intervals (CIs) for every study with either fixed or random effect models.

Results:

A full total of 1792 patients from 6 studies were enrolled. Our meta-analysis showed that transient hypoparathyroidism was significantly more frequent in bilateral CND group (OR = 0.58; 95% CI 0.44–0.76). The prevalence of permanent hypoparathyroidism was significantly higher in bilateral CND group patients compared to those in ipsilateral CND group (OR = 0.26; 95% CI 0.15–0.45). On the other hand, our meta-analysis indicated that there were no significant differences in the incidence of transient RLN injury, permanent RLN injury and local recurrence.

Conclusions:

Compared with bilateral CND, the rate of temporary and permanent hypoparathyroidism in ipsilateral CND is lower, but the local recurrence is similar. It may be presumptuous to suggest that ipsilateral CND is an adequate treatment for cN0 unilateral PTC.

KEYWORDS
Papillary thyroid carcinoma; Ipsilateral CND; Bilateral CND; Meta-analysis

HIGHLIGHTS

The permanent hypoparathyroidism was remarkably higher in patients in the bilateral CND group compared to the ipsilateral CND group.

Ipsilateral CND may be comparable to bilateral CND in terms of local recurrence and transient/permanent RLN injury.

Ipsilateral CND may be an appropriate treatment forcN0 unilateral PTC.

Author, year	Country	No. of patients	Sex (male/female)	Mean age (year)	Mean tumor size (mm)	Multifocality	Extrathyroidal extension	Time to recurrence (months)	Follow-up time (months)	Quality of score	Study design
Calò 2017⁹9 Calò PG, Lombardi CP, Podda F, Sessa L, Santini L, Conzo G, et al. Role of prophylactic central neck dissection in clinically node-negative differentiated thyroid cancer: assessment of the risk of regional recurrence. Updates Surg. 2017;69:241–8.	Italy	258	56/202	44.4 ± 11.8	Ipsi-CND 16.7± 10.7 Bil-CND 13.8 ± 7.5	Ipsi-CND 18/30 Bil-CND 21/30	-	-	Ipsi-CND 74.9 ± 19.2 Bil-CND 67.8±22.8	7/9	Retrospective
Giordano 2017⁶6 Giordano D, Frasoldati A, Gabrielli E, Pernice C, Zini M, Castellucci A, et al. Long-term outcomes of central neck dissection for cN0 papillary thyroid carcinoma. Am J Otolaryngol. 2017;38:576–81.	Italy	610	135/475	49 ±14	-	-	-	-	113 ±53	7/9	Retrospective
Kang 2020¹¹11 Kang JG, Kim YA, Choi JE, Lee SJ, Kang SH. The effectiveness of prophylactic ipsilateral central neck dissection in selected patients who underwent total thyroidectomy for clinically node-negative unilateral papillary thyroid carcinoma. Yeungnam Univ J Med. 2020;37:202–9.	Korea	174	0/174	Ipsi-CND 47.8 ± 11.2 Bil-CND 45.1 ± 10.2	Ipsi-CND 8±5 Bil-CND 9±6	Ipsi-CND 14/74 Bil-CND 16/100	Ipsi-CND 43/74 Bil-CND 66/100	-	Ipsi-CND 118.2 ± 4.6 Bil-CND 115.5 ± 4.1	8/9	Retrospective
Raffaelli 2012⁸8 Raffaelli M, De Crea C, Sessa L, Giustacchini P, Revelli L, Bellantone C, et al. Prospective evaluation of total thyroidectomy versus ipsilateral versus bilateral central neck dissection in patients with clinically node-negative papillary thyroid carcinoma. Surgery. 2012;152:957–64.	Italy	186	37/149	42.9± 11.5	12.6 ± 6.8	93/186	-	-	25.1 ±8.0	6/9	Retrospective
Sadowski 2009¹⁰10 Sadowski BM, Snyder SK, Lairmore TC. Routine bilateral central lymph node clearance for papillary thyroid cancer. Surgery. 2009;146:696–703.	US	180	-	-	1.26	-	-	-	38.8	6/9	Retrospective
Yoo 2018⁷7 Yoo HS, Shin MC, Ji YB, Song CM, Lee SH, Tae K, et al. Optimal extent of prophylactic central neck dissection for papillary thyroid carcinoma: comparison of unilateral versus bilateral central neck dissection. Asian J Surg. 2018;41:363–9.	Korea	384	63/321	Ipsi-CND 48.25 ± 11.76 Bil-CND 50.09± 12.56	Ipsi-CND 10.38 ±7.29 Bil-CND 11.15 ±6.48	Ipsi-CND 22/169 Bil-CND 28/215	Ipsi-CND 79/169 Bil-CND 113/215	Ipsi-CND 29.33 ±23.18 Bil-CND 48.71 ± 17.46	Ipsi-CND 58.91 ±28.55 Bil-CND 60.41 ±28.67	7/9	Retrospective

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] *Corresponding author. E-mail:doctorlao1980@163.com (L. Lao).

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Comparison of prophylactic ipsilateral and bilateral central lymph node dissection in papillary thyroid carcinoma: a meta-analysis☆ ☆ Peer Review under the responsibility of Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial.

Abstract

Objective:

Methods:

Results:

Conclusions:

HIGHLIGHTS

Comparison of prophylactic ipsilateral and bilateral central lymph node dissection in papillary thyroid carcinoma: a meta-analysis^☆ ☆ Peer Review under the responsibility of Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial.