Ningbo No.2 Hospital, Department of General Surgery, Ningbo, China.
Yuyao People's Hospital, Department of General Surgery, Zhejiang Province, China.
Braz J Otorhinolaryngol. 2023 Nov-Dec;89(6):101318. doi: 10.1016/j.bjorl.2023.101318. Epub 2023 Sep 4.
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.
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.
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.
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.
在患有甲状腺乳头状癌（PTC）的患者中，对气管旁（VI 级）淋巴结进行手术切除的范围仍存在争议。我们的研究目的是评估预防性同侧中央颈部淋巴结清扫术（CND）与双侧 CND 在全甲状腺切除时对临床淋巴结阴性（cN0）单侧 PTC 的有效性和安全性。
系统检索电子数据库，包括 Pubmed、Web of Science 和中国期刊网，检索时间从 1990 年 1 月至 2021 年 9 月。感兴趣的结局数据包括暂时性甲状旁腺功能减退症、永久性甲状旁腺功能减退症、暂时性喉返神经（RLN）损伤、永久性 RLN 损伤和局部复发。我们使用固定或随机效应模型对每项研究的汇总优势比（OR）和 95%置信区间（CI）进行了构建。
共有 6 项研究的 1792 名患者纳入本研究。我们的荟萃分析显示，双侧 CND 组暂时性甲状旁腺功能减退症的发生率明显更高（OR=0.58；95%CI 0.44-0.76）。双侧 CND 组患者永久性甲状旁腺功能减退症的发生率明显高于同侧 CND 组（OR=0.26；95%CI 0.15-0.45）。另一方面，我们的荟萃分析表明，暂时性 RLN 损伤、永久性 RLN 损伤和局部复发的发生率无显著差异。
与双侧 CND 相比，同侧 CND 暂时性和永久性甲状旁腺功能减退症的发生率较低，但局部复发率相似。因此，认为同侧 CND 是 cN0 单侧 PTC 的充分治疗方法可能是轻率的。
