Prophylactic Level VI Dissection for Stage cN<sub>0</sub> Papillary Thyroid Carcinoma: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 ZHANGLei , LIXin-xi , WANGYang , TIANYe , BAIChao ,  LUOJun

Department of Vascular and Thyroid Surgery, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China;

Corresponding?author：

LUOJun, Email: xmuluo@163.com

Keywords：

Prophylactic central neck dissection; Total thyroidectomy; Stage cN₀ papillary thyroid carcinoma; Systematic review; Meta-analysis

DOI：

10.7507/1672-2531.20150232

Video：

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Objective To systematically evaluate the effectiveness and safety of prophylactic central neck dissection (PCND) for stage cN₀ papillary thyroid carcinoma. Methods Databases including PubMed, EMbase, The Cochrane Library (Issue 1, 2015), WanFang Data, CBM and CNKI were searched to collect the studies about total thyroidectomy (TT)+PCND versus TT alone for stage cN₀ papillary thyroid carcinoma from inception to March 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, meta-analysis was performed by using RevMan 5.1 software. Results A total of 10 studies involving 3 661 patients were included. The results of meta-analysis showed that, compared with TT alone, TT+PCND had higher transient hypocalcemia (OR=2.50, 95%CI 2.05 to 3.03, P<0.000 01), higher permanent hypocalcemia (OR=3.11, 95%CI 1.82 to 5.30, P<0.000 1), and lower recurrence (OR=0.66, 95%CI 0.47 to 0.93, P=0.02). But there were no significant differences between two groups in transient laryngeal nerve palsy or permanent laryngeal nerve palsy. Conclusion TT+PCND is safe and feasible for treating stage cN₀ papillary thyroid carcinoma when its indications are strictly controlled. However, due to limited quantity and quality of the included studies, more high-quality randomized controlled trials are needed to verify the abovementioned conclusion.

Citation： ZHANGLei, LIXin-xi, WANGYang, TIANYe, BAIChao, LUOJun. Prophylactic Level VI Dissection for Stage cN₀ Papillary Thyroid Carcinoma: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(12): 1424-1430. doi: 10.7507/1672-2531.20150232 Copy

1.	Fritze D, Doherty GM, Fritze D, et al. Surgical Management of Cervical Lymph Nodes in Differentiated Thyroid Cancer. Otolaryngol Clin North Am, 2010, 43(2):285-300.
2.	Iyer NG, Shaha AR. Central compartment dissection for well differentiated thyroid cancer and the band plays on. Curr Opin Otolaryngol Head Neck Surg, 2011, 19(2):106-112.
3.	Sobin LH, Gospodarowicz MK, Wittenkind C. 惡性腫瘤TNM分期. 周清華, 孫燕, 譯. 7版. 天津:天津科技出版公司, 2012:57-62.
4.	Wells G, Shea B, O'connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in metaanalyses. Ottawa, Canada:Dept of pidemiology and Community Medicine, University of Ottawa.
5.	Roh JL, Park JY, Chan IP. Total Thyroidectomy Plus Neck Dissection in Differentiated Papillary Thyroid Carcinoma Patients. Ann Surg, 2007, 245(4):604-610.
6.	Shen WT, Ogawa L, Ruan D, et al. Central neck lymph node dissection for papillary thyroid cancer:the reliability of surgeon judgment in predicting which patients will benefit. Surgery, 2010, 148(2):398-403.
7.	Popadich A, Levin O, Lee JC, et al. A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN.
8.	papillary thyroid cancer. Surgery, 2011, 150(6):1048-1055.
9.	Lang HH, Kai PW, Wan KY, et al. Impact of routine unilateral central neck dissection on preablative and postablative stimulated thyroglobulin levels after total thyroidectomy in papillary thyroid carcinoma. Ann Surg Onco, 2012, 19(1):60-67.
10.	Raffaelli M, De CC, Sessa L, 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(6):957-964.
11.	So YK, Seo MY, Son YI. Prophylactic central lymph node dissection for clinically node-negative papillary thyroid microcarcinoma: influence on serum thyroglobulin level, recurrence rate, and postoperative complications. Surgery, 2012, 151(2):192-198.
12.	Barczyński M, Konturek A, Stopa M, et al. Prophylactic central neck dissection for papillary thyroid cancer. Br J Surg, 2013, 100(3):410-418.
13.	Calò PG, Pisano G, Medas F, et al. Total thyroidectomy without prophylactic central neck dissection in clinically node-negative papillary thyroid cancer:is it an adequate treatment?. World J Surg Oncol, 2014, 12(21):152.
14.	Conzo G, Calò PG, Sinisi AA, et al. Impact of prophylactic central compartment neck dissection on locoregional recurrence of differentiated thyroid cancer in clinically node-negative patients:a retrospective study of a large clinical series. Surgery, 2014, 155(6): 998-1005.
15.	Zhang L, Liu Z, Liu Y, et al. The clinical prognosis of patients with cN₀ papillary thyroid microcarcinoma by central neck dissection. World J Surg Oncol, 2015, 13(1):138.
16.	李舍予, 李蕓, 周方勵, 等. 2011年四川大學華西醫院內分泌代謝科甲狀腺疾病住院患者費用情況調查. 中國循證醫學雜志, 2013, 13(11):1298-1302.
17.	Palazzo FF, Gosnell J, Savio R, et al. Lymphadenectomy for papillary thyroid cancer:changes in practice over four decades. Eur J Surg Oncol, 2006, 32(3):340-344.
18.	馬媛媛, 張曉光, 帕麗達·帕爾哈提, 等. 國內超聲彈性成像對甲狀腺良惡性結節鑒別診斷價值的Meta分析. 中國循證醫學雜志, 2014, 14(5):584-591.
19.	王尚前, 邵國安, 胡學軍, 等. 甲狀腺、甲狀旁腺術后常規引流的系統評價. 中國循證醫學雜志, 2012,12(7):830-839.
20.	Ihre LC, Per H, Paul WD, et al. Clinically significant prognostic factors for differentiated thyroid carcinoma. Cancer, 2006, 106(3): 524-531.
21.	孫團起, 吳毅. 領式切口保留頸叢擇區性頸部淋巴結清掃術治療分化型甲狀腺癌112例分析. 中國實用外科雜志, 2011, 31(5):411-413.
22.	Choi YJ, Ji SY, Kook SH, et al. Clinical and imaging assessment of cervical lymph node metastasis in papillary thyroid carcinomas. World J Surg, 2010, 34(7):1494-1499.
23.	Vergez S, Sarini J, Percodani J, et al. Lymph node management in clinically node-negative patients with papillary thyroid carcinoma. Eur J Surg Oncol, 2010, 36(8):777-782.
24.	Park JP, Roh JL, Lee JH, et al. Risk factors for central neck lymph node metastasis of clinically noninvasive, node-negative papillary thyroid microcarcinoma. Am J Surg, 2014, 208(3):412-418.
25.	Roh J, Kim J, Chan IP. Central cervical nodal metastasis from papillary thyroid microcarcinoma:pattern and factors predictive of nodal metastasis. Ann Surg Onco, 2008, 15(9):2482-2486.
26.	Rotstein L. The role of lymphadenectomy in the management of papillary carcinoma of the thyroid. J Surg Oncol, 2009, 99(4):186-188.
27.	Eun LK, Yong C, Kang E, et al. Ipsilateral and contralateral central lymph node metastasis in papillary thyroid cancer:Patterns and predictive factors of nodal metastasis. Head Nec, 2013, 35(5):672-676.
28.	Young GE, Young CL, Kee HK. Predictive Factors of Contralateral Paratracheal Lymph Node Metastasis in Papillary Thyroid Cancer Prospective Multicenter Study. Otolaryngol Head Neck Surg, 2014, 150(2):210-215.
29.	Lu Z, Zhang Y, Wei S, et al. Outcome of papillary thyroid microcarcinoma:study of 1990 cases. Mol Clin Oncol, 2015, 3(3): 672-676.
30.	American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 2009, 19(2):1167-1214.
31.	Palestini N, Borasi AL, Freddi M, et al. Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience. Langenbecks Arch Surg, 2008, 393(5):693-698.
32.	Giordano D, Valcavi R, Thompson GB, et al. Complications of Central Neck Dissection in Patients with Papillary Thyroid Carcinoma:Results of a Study on 1087 Patients and Review of the Literature. Thyroid, 2012, 22(9):911-917.
33.	Edward JC, Kulinskaya E, Neil S, et al. Systematic review and metaanalysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone. Laryngoscope, 2009, 119(6):1135-1139.
34.	Henry JF, Gramatica L, Denizot A, et al. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg, 1998, 383(2): 167-169.
35.	Koo BS, Choi EC, Yoon YH, et al. Predictive factors for ipsilateral or contralateral central lymph node metastasis in unilateral papillary thyroid carcinoma. Ann Surg, 2009, 249(5):840-844.
36.	Cornford L, Roach P, Stalberg P, et al. Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery, 2006, 140(6):1000-1007.
37.	Khairy GA, Al-Saif A. Incidental parathyroidectomy during thyroid resection:incidence, risk factors, and outcome. Ann Saudi Med, 2011, 31(3):274-278.
38.	康德英, 洪旗, 劉關鍵, 等. Meta分析中發表性偏倚的識別與處理. 中國循證醫學雜志, 2003, 3(1):45-49.

1. Fritze D, Doherty GM, Fritze D, et al. Surgical Management of Cervical Lymph Nodes in Differentiated Thyroid Cancer. Otolaryngol Clin North Am, 2010, 43(2):285-300.
2. Iyer NG, Shaha AR. Central compartment dissection for well differentiated thyroid cancer and the band plays on. Curr Opin Otolaryngol Head Neck Surg, 2011, 19(2):106-112.
3. Sobin LH, Gospodarowicz MK, Wittenkind C. 惡性腫瘤TNM分期. 周清華, 孫燕, 譯. 7版. 天津:天津科技出版公司, 2012:57-62.
4. Wells G, Shea B, O'connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in metaanalyses. Ottawa, Canada:Dept of pidemiology and Community Medicine, University of Ottawa.
5. Roh JL, Park JY, Chan IP. Total Thyroidectomy Plus Neck Dissection in Differentiated Papillary Thyroid Carcinoma Patients. Ann Surg, 2007, 245(4):604-610.
6. Shen WT, Ogawa L, Ruan D, et al. Central neck lymph node dissection for papillary thyroid cancer:the reliability of surgeon judgment in predicting which patients will benefit. Surgery, 2010, 148(2):398-403.
7. Popadich A, Levin O, Lee JC, et al. A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN.
8. papillary thyroid cancer. Surgery, 2011, 150(6):1048-1055.
9. Lang HH, Kai PW, Wan KY, et al. Impact of routine unilateral central neck dissection on preablative and postablative stimulated thyroglobulin levels after total thyroidectomy in papillary thyroid carcinoma. Ann Surg Onco, 2012, 19(1):60-67.
10. Raffaelli M, De CC, Sessa L, 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(6):957-964.
11. So YK, Seo MY, Son YI. Prophylactic central lymph node dissection for clinically node-negative papillary thyroid microcarcinoma: influence on serum thyroglobulin level, recurrence rate, and postoperative complications. Surgery, 2012, 151(2):192-198.
12. Barczyński M, Konturek A, Stopa M, et al. Prophylactic central neck dissection for papillary thyroid cancer. Br J Surg, 2013, 100(3):410-418.
13. Calò PG, Pisano G, Medas F, et al. Total thyroidectomy without prophylactic central neck dissection in clinically node-negative papillary thyroid cancer:is it an adequate treatment?. World J Surg Oncol, 2014, 12(21):152.
14. Conzo G, Calò PG, Sinisi AA, et al. Impact of prophylactic central compartment neck dissection on locoregional recurrence of differentiated thyroid cancer in clinically node-negative patients:a retrospective study of a large clinical series. Surgery, 2014, 155(6): 998-1005.
15. Zhang L, Liu Z, Liu Y, et al. The clinical prognosis of patients with cN₀ papillary thyroid microcarcinoma by central neck dissection. World J Surg Oncol, 2015, 13(1):138.
16. 李舍予, 李蕓, 周方勵, 等. 2011年四川大學華西醫院內分泌代謝科甲狀腺疾病住院患者費用情況調查. 中國循證醫學雜志, 2013, 13(11):1298-1302.
17. Palazzo FF, Gosnell J, Savio R, et al. Lymphadenectomy for papillary thyroid cancer:changes in practice over four decades. Eur J Surg Oncol, 2006, 32(3):340-344.
18. 馬媛媛, 張曉光, 帕麗達·帕爾哈提, 等. 國內超聲彈性成像對甲狀腺良惡性結節鑒別診斷價值的Meta分析. 中國循證醫學雜志, 2014, 14(5):584-591.
19. 王尚前, 邵國安, 胡學軍, 等. 甲狀腺、甲狀旁腺術后常規引流的系統評價. 中國循證醫學雜志, 2012,12(7):830-839.
20. Ihre LC, Per H, Paul WD, et al. Clinically significant prognostic factors for differentiated thyroid carcinoma. Cancer, 2006, 106(3): 524-531.
21. 孫團起, 吳毅. 領式切口保留頸叢擇區性頸部淋巴結清掃術治療分化型甲狀腺癌112例分析. 中國實用外科雜志, 2011, 31(5):411-413.
22. Choi YJ, Ji SY, Kook SH, et al. Clinical and imaging assessment of cervical lymph node metastasis in papillary thyroid carcinomas. World J Surg, 2010, 34(7):1494-1499.
23. Vergez S, Sarini J, Percodani J, et al. Lymph node management in clinically node-negative patients with papillary thyroid carcinoma. Eur J Surg Oncol, 2010, 36(8):777-782.
24. Park JP, Roh JL, Lee JH, et al. Risk factors for central neck lymph node metastasis of clinically noninvasive, node-negative papillary thyroid microcarcinoma. Am J Surg, 2014, 208(3):412-418.
25. Roh J, Kim J, Chan IP. Central cervical nodal metastasis from papillary thyroid microcarcinoma:pattern and factors predictive of nodal metastasis. Ann Surg Onco, 2008, 15(9):2482-2486.
26. Rotstein L. The role of lymphadenectomy in the management of papillary carcinoma of the thyroid. J Surg Oncol, 2009, 99(4):186-188.
27. Eun LK, Yong C, Kang E, et al. Ipsilateral and contralateral central lymph node metastasis in papillary thyroid cancer:Patterns and predictive factors of nodal metastasis. Head Nec, 2013, 35(5):672-676.
28. Young GE, Young CL, Kee HK. Predictive Factors of Contralateral Paratracheal Lymph Node Metastasis in Papillary Thyroid Cancer Prospective Multicenter Study. Otolaryngol Head Neck Surg, 2014, 150(2):210-215.
29. Lu Z, Zhang Y, Wei S, et al. Outcome of papillary thyroid microcarcinoma:study of 1990 cases. Mol Clin Oncol, 2015, 3(3): 672-676.
30. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer, Cooper DS, Doherty GM, et al. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid, 2009, 19(2):1167-1214.
31. Palestini N, Borasi AL, Freddi M, et al. Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience. Langenbecks Arch Surg, 2008, 393(5):693-698.
32. Giordano D, Valcavi R, Thompson GB, et al. Complications of Central Neck Dissection in Patients with Papillary Thyroid Carcinoma:Results of a Study on 1087 Patients and Review of the Literature. Thyroid, 2012, 22(9):911-917.
33. Edward JC, Kulinskaya E, Neil S, et al. Systematic review and metaanalysis of the adverse effects of thyroidectomy combined with central neck dissection as compared with thyroidectomy alone. Laryngoscope, 2009, 119(6):1135-1139.
34. Henry JF, Gramatica L, Denizot A, et al. Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg, 1998, 383(2): 167-169.
35. Koo BS, Choi EC, Yoon YH, et al. Predictive factors for ipsilateral or contralateral central lymph node metastasis in unilateral papillary thyroid carcinoma. Ann Surg, 2009, 249(5):840-844.
36. Cornford L, Roach P, Stalberg P, et al. Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery, 2006, 140(6):1000-1007.
37. Khairy GA, Al-Saif A. Incidental parathyroidectomy during thyroid resection:incidence, risk factors, and outcome. Ann Saudi Med, 2011, 31(3):274-278.
38. 康德英, 洪旗, 劉關鍵, 等. Meta分析中發表性偏倚的識別與處理. 中國循證醫學雜志, 2003, 3(1):45-49.

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Prophylactic Level VI Dissection for Stage cN₀ Papillary Thyroid Carcinoma: A Meta-analysis

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Chinese Journal of Evidence-Based Medicine

Prophylactic Level VI Dissection for Stage cN0 Papillary Thyroid Carcinoma: A Meta-analysis

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Prophylactic Level VI Dissection for Stage cN₀ Papillary Thyroid Carcinoma: A Meta-analysis