ObjectiveTo systematically evaluate effectiveness and safety of total thyroidectomy(TT) plus prophylactic central neck dissection(PCND) versus TT for stage cN0 papillary thyroid carcinoma(PTC). MethodsDatabases including PubMed, EMbase, The Cochrane Library(Issue1, 2015), WanFang Data, CBM, and CNKI were searched to collect the randomized controlled trails(RCTs) and non-RCTs about TT+PCND versus TT for stage cN0 PTC. The retrieval time was from inception to March 2015. The studies were screened according to the inclusion and exclusion criteria, the data were extracted and the quality was evaluated independently by 2 reviewers. Then the meta-analysis was conducted using RevMan 5.1 software. ResultsA total of 10 non-RCTs involving 3 661 patients were included. There were 1 774 cases in the TT+PCND group and 1 887 cases in the TT group. The results of meta-analysis showed that: Related to postoperative complications, compared with TT group, the postoperative transient hypocalcemia rate〔OR=0.40, 95% CI(0.33, 0.49), P < 0.000 01〕and permanent hypocalcemia rate were higher〔OR=0.32, 95% CI(0.19, 0.55), P < 0.000 1〕, the recurrence rate was lower〔OR=1.51, 95% CI(1.07, 2.13), P=0.02〕in the TT+PCND group. But there were no differences in the transient laryngeal nerve palsy rate〔OR=0.73, 95% CI(0.49, 1.09), P=0.13〕and permanent laryngeal nerve palsy rate〔OR=0.87, 95% CI(0.50, 1.52), P=0.62〕between the 2 groups. ConclusionsTT+PCND is superior to TT in treating stage cN0 PTC for it's lower recurrence, but it is raising transient hypocalcemia and permanent hypocalcemia rate at the same time. And it is similar as TT in transient laryngeal nerve palsy and permanent laryngeal nerve palsy rate. So TT+PCND is safe and feasible for treating stage cN0 PTC when its indications are strictly controlled. However, for the quantity and quality limitation of the included studies, this conclusion still requires to be further proved by performing large scale and high quality RCTs. It suggests that doctors should choose a best therapy for stage cN0 PTC patients according to an integrative disease assessment.
ObjectiveTo systematically evaluate the effectiveness and safety of prophylactic central neck dissection (PCND) for stage cN0 papillary thyroid carcinoma. MethodsDatabases 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. ResultsA 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. ConclusionTT+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.