Comparative Study between Total Thyroidectomy with Ipsilateral versus Bilateral Prophylactic Central Neck Dissection in Patients with Clinically Node–Negative Papillary Thyroid Carcinoma –A Meta-Analysis

Abstract

apillary thyroid carcinoma (PTC) accounts for > 80% of all thyroid malignancies. It is generally slow-growing and the overall prognosis is excellent, with 5-year, 10-year, and 20-year survival rates of 94%, 89%, and 87%, respectively. Cervical lymph node metastasis occurs frequently in PTC and is an unfavorable prognostic factor, especially in patients over 45 years. The central neck compartment is considered to be the primary echelon of lymph node metastasis in PTC. The occult metastasis rate ranges from 20% to 90% in patients who have undergone prophylactic central neck dissection (pCND). Although PTC has an excellent prognosis, loco regional recurrence has been reported in up to 30% of patients. It is related to increased morbidity and mortality rates, and a poor prognosis. Loco regional recurrence was more frequent in patients with lymph node metastasis than in those without it. Also, extracapsular spread of metastatic lymph nodes and maximal extrathyroidal extension of tumors are important prognostic factors for loco regional recurrence in PTC. Total thyroidectomy (TT) is the standard surgical procedure for patients with PTC. Other surgical strategies such as hemi thyroidectomy and thyroid lobectomy are also viable. Regional lymph node metastasis is detected in 40–90% of recurrent cases. and is an independent risk factor for loco regional recurrence (LRR) and mortality in patients with PTC.