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.
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/pCCNDpatients, 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.
Authors: Juan J Sancho; Thomas W Jay Lennard; Ivan Paunovic; Frédéric Triponez; Antonio Sitges-Serra Journal: Langenbecks Arch Surg Date: 2013-12-19 Impact factor: 3.445
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Authors: Bryan R Haugen; Erik K Alexander; Keith C Bible; Gerard M Doherty; Susan J Mandel; Yuri E Nikiforov; Furio Pacini; Gregory W Randolph; Anna M Sawka; Martin Schlumberger; Kathryn G Schuff; Steven I Sherman; Julie Ann Sosa; David L Steward; R Michael Tuttle; Leonard Wartofsky Journal: Thyroid Date: 2016-01 Impact factor: 6.568