Medical College of Wisconsin
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A meta-analysis of the effect of prophylactic central compartment neck dissection on locoregional recurrence rates in patients with papillary thyroid cancer. Ann Surg Oncol 2013 Oct;20(11):3477-83

Date

07/13/2013

Pubmed ID

23846784

DOI

10.1245/s10434-013-3125-0

Scopus ID

2-s2.0-84883781669 (requires institutional sign-in at Scopus site)   153 Citations

Abstract

BACKGROUND: It is not known whether prophylactic central compartment neck dissection (pCCND) in conjunction with total thyroidectomy decreases rates of locoregional recurrence in patients with papillary thyroid cancer (PTC).

METHODS: A meta-analysis was performed of reported recurrence rates of clinically node-negative PTC in patients treated with total thyroidectomy (TT) alone, or TT and pCCND. The primary outcome was locoregional recurrence of PTC.

RESULTS: Eleven studies capturing 2,318 patients met the inclusion criteria. Overall, the recurrence rate for patients undergoing TT/pCCND was 3.8 % [95 % confidence interval (CI) 2.3-5.8]. In the six comparative studies, which included 1,740 patients, 995 patients undergoing TT and 745 patients undergoing TT/pCCND, the overall recurrence rate was 7.6:7.9 % in the TT group and 4.7 % in the TT/pCCND group. The relative risk of recurrence was 0.59 (95 % CI 0.33-1.07), favoring a lower recurrence rate in the TT/pCCND arm. The number of patients that would need to be treated (NNT) in order to prevent a single recurrence is 31. The relative risk for permanent hypocalcemia was 1.82 (95 % CI 0.51-6.5) and for permanent recurrent laryngeal nerve injury was 1.14 (95 % CI 0.46-2.83).

CONCLUSIONS: There was no difference in recurrence or long-term complication rates between patients undergoing TT or TT/pCCND. There was a trend toward lower recurrence rates in TT/pCCND patients, with a NNT of 31 patients. On the basis of these data, routine pCCND might be considered in the hands of high-volume surgeons treating patients with clinically node-negative PTC.

Author List

Wang TS, Cheung K, Farrokhyar F, Roman SA, Sosa JA

Author

Tracy S. Wang MPH, MD Professor in the Surgery department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Carcinoma
Carcinoma, Papillary
Humans
Lymph Node Excision
Neoplasm Recurrence, Local
Postoperative Complications
Prognosis
Recurrent Laryngeal Nerve Injuries
Thyroid Neoplasms
Thyroidectomy