Department of Surgical Oncology, Ningbo NO. 2 Hospital, 315010 Ningbo, China.
Department of Surgical Oncology, Ningbo NO. 2 Hospital, 315010 Ningbo, China.
Eur Ann Otorhinolaryngol Head Neck Dis. 2019 Nov;136(6):481-487. doi: 10.1016/j.anorl.2018.07.010. Epub 2019 Jun 10.
Prophylactic 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.
The 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.
Twenty-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).
The 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>1cm was necessary.
在临床淋巴结阴性（cN0）甲状腺乳头状癌（PTC）患者中，甲状腺全切除术（TT）时预防性中央颈部清扫术（CND）仍然存在争议。本系统评价和荟萃分析旨在比较接受 TT+CND 与单独 TT 的患者之间的局部复发率。
通过检索国家和国际在线数据库，检索了 1990 年 1 月至 2017 年 10 月发表的关于 TT+预防性 CND 与 TT 治疗 PTC 的文献。提取数据后进行荟萃分析。
共有 25 项研究符合纳入标准，比较了 TT+CND 与 TT 单独治疗的效果。对于 PTC 和甲状腺微小乳头状癌（PTMC），TT+CND 组的总复发率明显低于 TT 单独组。TT 单独组中央区复发率明显高于 TT+CND 组（OR=3.41，95%Cl [2.00∼5.80]，P<0.00001），而两组间侧区复发率无显著差异（OR=1.19，95%Cl [0.81∼1.77]，P=0.38）。我们比较了同侧 CND+TT 与 TT 单独治疗，发现两组之间的复发率无显著差异（OR=1.44，95%Cl [0.74∼2.81]，P=0.28）。另一方面，双侧 CND+TT 显示出明显较低的复发率（OR=2.48，95%Cl [1.75∼3.53]，P<0.00001）。
与单独 TT 相比，TT+CND 可显著降低局部复发风险，特别是预防中央颈部复发。此外，我们发现 PTC>1cm 的患者需要双侧 CND。
