Lateral neck dissection for well-differentiated thyroid carcinoma: a systematic review.

ABSTRACT

OBJECTIVES/HYPOTHESIS: Management of the lateral neck in well-differentiated thyroid carcinoma (WDTC) remains a topic of ongoing debate. A systematic review was performed to determine if patients with WDTC who undergo lateral neck dissection (LND) have significantly different survival, recurrence, or procedure-related complication rates, as compared to those who do not. DATA SOURCES A computerized search of MEDLINE from 1966 to October 2012 was performed, supplemented with manual searches. REVIEW METHODS: A priori criteria were used to evaluate 924 studies. Data extraction was performed by independent reviewers and focused on survival, recurrence, postoperative complications, study designs, and potential confounders. RESULTS: Forty-seven criterion-meeting studies included 24,153 participants. Stage-specific data were limited. The small volume of data specific to the N0 neck (n=3 studies, 6.3%) demonstrates no difference in disease-free survival (DFS) or recurrence with versus without LND. The data regarding the N+ neck (n=14 studies, 29.2%) were mixed with regard to the impact of LND on DFS and recurrence. The preponderance of data was reported in analyses of mixed or unreported nodal status (n=31 studies, 64.6%). Among these studies, the majority reported no difference in overall survival, DFS, disease-specific survival, or recurrence, but overall data were mixed and subject to confounding by indication and limitations in power. CONCLUSIONS: Data regarding the impact of LND on survival, recurrence, and postoperative complications are mixed. Routine prophylactic LND for WDTC does not have a clearly advantageous risk-to-benefit ratio.