Prophylactic Central Lymph Node Dissection Versus Thyroidectomy Alone in Clinically Node-Negative Thyroid Cancer: A Systematic Review and Meta-Analysis

Abstract

Background

The role of prophylactic central neck dissection (pCND) in clinically node-negative (cN0) thyroid cancer patients remains debated. Although pCND may enhance staging and reduce recurrence, it also carries risks such as hypoparathyroidism and laryngeal nerve injury. This meta-analysis of randomized controlled trials (RCTs) aims to provide more robust evidence regarding the benefits and risks of pCND.

Methods

A systematic review and meta-analysis were conducted following PRISMA guidelines. Eligible RCTs comparing thyroidectomy with and without pCND were identified through searches of PubMed, EMBASE, Web of Science, and Cochrane Library up to September 2025. Data extraction, bias assessment, and synthesis were independently performed.

Results

Seven RCTs comprising 1,484 patients were included. pCND significantly increased lymph node metastasis detection (OR 7.43, p<0.001), but showed no clear evidence of reduction in recurrence/persistence (OR 1.09, p=0.80) or overall survival (OR 1.45, p=0.82). Although not statistically significant, there was a consistent trend toward increased postoperative morbidity with pCND (OR 1.55, p=0.11), particularly hypoparathyroidism.

Conclusion

Current RCT evidence indicates that pCND in cN0 thyroid cancer improves pathological staging but does not demonstrably reduce recurrence/persistence or improve survival. Given the associated risk of surgical morbidity, these findings suggest pCND serves a primarily prognostic rather than therapeutic role. Consequently, routine pCND may not be broadly applicable; instead, selective use tailored to individual patient characteristics and surgical expertise appears more appropriate.

Keywords

thyroid cancer prophylactic central neck dissection clinically node-negative randomized controlled trials meta-analysis

Significance Statement

Prophylactic central neck dissection (pCND) in clinically node-negative thyroid cancer improves lymph node metastasis detection but does not reduce recurrence/persistence rates or enhance survival. This meta-analysis highlights the diagnostic benefit of pCND while revealing its association with increased surgical morbidity, especially hypoparathyroidism. These findings underscore the need for selective application of pCND, emphasizing its role in staging rather than therapy, and call for individualized treatment decisions based on patient risk and surgical expertise.

1. Introduction

The management of clinically node-negative (cN0) thyroid cancer presents a persistent surgical dilemma centered on the role of prophylactic central neck dissection (pCND). Defined as the elective resection of central compartment (Level VI) lymph nodes in the absence of preoperative nodal involvement, pCND is primarily justified by its potential to refine pathological staging through the detection of occult lymph node metastases (LNM).^1,2 A key theoretical extension of this improved staging is the subsequent reduction in the risk of locoregional recurrence/persistence.³

However, this potential oncologic benefit is counterbalanced by concerns regarding increased surgical morbidity. The central neck compartment contains vital structures—specifically, the parathyroid glands and recurrent laryngeal nerves—that are highly vulnerable during dissection.⁴ Consequently, pCND inherently elevates the risk of complications, such as hypoparathyroidism (HPT) and laryngeal nerve palsy (LNP), which can significantly compromise patient quality of life.^3,5 Thus, the fundamental clinical equipoise rests on a precise risk-benefit calculus: whether the diagnostic and potential therapeutic advantages of pCND outweigh its associated complication profile.

Although prior observational studies and meta-analyses have informed this debate, they are constrained by significant methodological limitations. Non-randomized designs are inherently susceptible to selection bias and confounding, as surgeons may preferentially perform pCND in patients perceived to be at higher risk.⁶ While these studies consistently report that pCND increases LNM detection, evidence regarding its impact on recurrence/persistence remains inconsistent, with some analyses suggesting a benefit and others demonstrating none.^3,5,7 Similarly, conclusions regarding the procedure’s safety profile, particularly concerning HPT and nerve injury, have been variable and are often underpowered.^3,7 Furthermore, many existing syntheses are outdated or incorporate lower levels of evidence, leaving the risk-benefit profile of pCND inadequately defined by the highest standard of evidence—randomized controlled trials (RCTs).⁷

In this context, the recent emergence of several RCTs provides a critical opportunity for a definitive, unbiased assessment. This systematic review and meta-analysis aims to resolve the ongoing controversy by synthesizing data exclusively from RCTs. Specifically, it seeks to provide high-level evidence on three core outcomes that directly address the clinical equipoise: (1) the effect of pCND on occult LNM detection; (2) its impact on recurrence/persistence; and (3) its associated risks concerning key surgical complications, namely HPT, LNP, and overall complication rates. By offering a precise quantification of this balance, our study endeavors to inform evidence-based surgical decision-making, patient counseling, and the development of clinical guidelines.^2,8

2. Methods

2.1. Registry Information

This systematic review and meta-analysis was registered with PROSPERO (Registration number: CRD420251157666). Ethical approval and informed consent were not required, as the study involved secondary data analysis. The study was conducted in strict compliance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines.

2.2. Sources and Inclusion and Exclusion Criteria

The literature search was performed in PubMed, EMBASE, Web of Science, and the Cochrane Library, from database inception up to September 2, 2025. Only studies published in English were considered. The search strategy was designed to identify RCTs comparing thyroidectomy with pCND versus thyroidectomy alone in patients with thyroid cancer. It employed a combination of controlled vocabulary (e.g., MeSH in PubMed, Emtree in EMBASE) and free-text keywords related to three core concepts: (1) thyroid neoplasms, (2) lymph node dissection, and (3) randomized controlled trials. The literature search was conducted independently by two reviewers (X.Z. and J.J.). Any discrepancies were resolved through discussion with a third reviewer (Z.Z.). The detailed search strategy for each database is provided in Table 1.

Table 1.

Search Strategy

Search database	Searching strategy	Search term
Pubmed	#1	(“thyroid neoplasms”[MeSH Terms] OR “thyroid neoplasm”[Title/Abstract] OR “thyroid carcinoma”[Title/Abstract] OR “thyroid carcinomas”[Title/Abstract] OR “cancer of the thyroid”[Title/Abstract] OR “cancer of thyroid”[Title/Abstract] OR “thyroid cancers”[Title/Abstract] OR “thyroid cancer”[Title/Abstract] OR “thyroid adenoma”[Title/Abstract] OR “thyroid adenomas”[Title/Abstract] OR “PTC”[Title/Abstract] OR “FTC”[Title/Abstract] OR “ATC”[Title/Abstract]) AND (“lymph node excision”[MeSH Terms] OR “lymph node excisions”[Title/Abstract] OR “Lymphadenectomy”[Title/Abstract] OR “Lymphadenectomies”[Title/Abstract] OR “lymph node dissection”[Title/Abstract] OR “lymph node dissections”[Title/Abstract] OR “neck dissection”[Title/Abstract] OR “central compartment dissection”[Title/Abstract] OR “central compartment dissection”[Title/Abstract]) AND (“randomized controlled trial”[Publication Type] OR “controlled clinical trial”[Publication Type] OR “clinical trials as topic”[MeSH Terms:noexp] OR “trial”[Title] OR “random”[Title/Abstract] OR “placebo”[Title/Abstract])
Pubmed	Filter
Cochrane Library	#1	MeSH descriptor: [Lymph Node Excision] explode all trees
	#2	(Lymphadenectomy):ti,ab,kw OR (Lymph Node Dissection):ti,ab,kw OR (neck dissection):ti,ab,kw OR (central compartment dissection):ti,ab,kw OR (lateral neck dissection):ti,ab,kw
	#3	(Lymphadenectomies):ti,ab,kw OR (Lymph Node Dissections):ti,ab,kw OR (Lymph Node Excisions):ti,ab,kw
	#4	#1 OR #2 OR #3
	#5	MeSH descriptor: [Thyroid Neoplasms] explode all trees
	#6	(Thyroid Neoplasm):ti,ab,kw OR (Thyroid Carcinoma):ti,ab,kw OR (Thyroid Carcinomas):ti,ab,kw OR (Cancer of the Thyroid):ti,ab,kw OR (Cancer of Thyroid):ti,ab,kw
	#7	(Thyroid Cancers):ti,ab,kw OR (Thyroid Cancer):ti,ab,kw OR (Thyroid Adenoma):ti,ab,kw OR (Thyroid Adenomas):ti,ab,kw OR (PTC):ti,ab,kw
	#8	(FTC):ti,ab,kw OR (ATC):ti,ab,kw
	#9	5 OR #6 OR #7 OR #8
	#10	#4 AND #9 in Trials
EMBASE	#1	‘lymph node dissection’/exp OR ‘lymph node excisions’:ab,ti OR lymphadenectomy:ab,ti OR lymphadenectomies:ab,ti OR ‘lymph node dissection’:ab,ti OR ‘lymph node dissections’:ab,ti OR ‘neck dissection’:ab,ti OR ‘central compartment dissection':ab,ti OR ‘lateral neck dissection':ab,ti
	#2	‘thyroid tumor’/exp OR ‘thyroid neoplasm’:ab,ti OR ‘thyroid carcinoma’:ab,ti OR ‘thyroid adenoma’:ab,ti OR ‘thyroid cancer’:ab,ti OR ptc:ab,ti OR ftc:ab,ti OR atc:ab,ti
	#3	‘controlled clinical trial’/exp OR ‘placebo’:ab,ti OR random:ab,ti OR ‘trial’:ti
	#4	#1 AND #2 AND #3
	#5	#4 AND ‘randomized controlled trial’/de
Web of Science	#1	random* (Title) OR placebo* (Title) OR trial (Title) OR random* (Abstract) OR placebo* (Abstract) and Preprint Citation Index (Exclude – Database)
	#2	Lymph Node Excision (Topic) OR Lymph Node Excisions (Topic) OR Lymphadenectomy (Topic) OR Lymphadenectomies (Topic) OR Lymph Node Dissection (Topic) OR Lymph Node Dissections (Topic) OR neck dissection (Topic) OR central compartment dissection (Topic) OR lateral neck dissection (Topic) and Preprint Citation Index (Exclude – Database)
	#3	Thyroid Neoplasms (Topic) OR Thyroid Neoplasm (Topic) OR Thyroid Carcinoma (Topic) OR Thyroid Carcinomas (Topic) OR Cancer of the Thyroid (Topic) OR Thyroid Cancers (Topic) OR Cancer of Thyroid (Topic) OR Thyroid Cancer (Topic) OR Thyroid Adenoma (Topic) OR Thyroid Adenomas (Topic) OR PTC (Topic) OR FTC (Topic) OR ATC (Topic) and Preprint Citation Index (Exclude – Database)
	#4	#1 AND #2 AND #3 and Preprint Citation Index (Exclude – Database)

Eligible studies were RCTs comparing pCND versus thyroidectomy alone in patients with cN0 thyroid cancer. This definition restricted the analysis to prophylactic dissection and excluded therapeutic dissection performed for clinically evident nodal disease. Included trials were required to report at least one of the following outcomes: recurrence/persistence, LNM, HPT, LNP, or overall complication rates.

2.3. Data Selection

Title and abstract screening, as well as full-text assessment, were each performed independently by two reviewers (X.Z. and J.J.). Duplicate records were identified and removed using Endnote. Any disagreements at each stage of the selection process were resolved first through discussion between the two reviewers to reach consensus; if unresolved, a third reviewer (Z.Z.) was consulted. This process ensured a systematic and unbiased study selection.

2.4. Data Extraction and Processing

Data extraction was performed independently by two reviewers (J.J. and X.Z.) using a pre-piloted form. Extracted details included: study location (country/region), follow-up duration (months), patient population, sample size (intervention/control groups), mean age (± standard deviation), sex distribution, disease type, tumor stage and size, intervention type, dissection extent, surgical approach, and control group measure. Any discrepancies between the two reviewers were resolved through consensus or, when necessary, by consultation with a third reviewer (Z.Z.).

2.5. Outcomes

The primary outcomes of this meta-analysis were recurrence/persistence and LNM, as these endpoints directly evaluate the core oncological efficacy of pCND. Secondary outcomes encompassed key procedure-related morbidity measures, specifically HPT, LNP, and overall complication rates. This structured classification provides a framework for evaluating both the potential benefits and risks associated with pCND, contextualizing its overall clinical value.

2.6. Synthesis Methods

Data synthesis was performed using R (version 4.3.2). Effect sizes were calculated as mean differences (MDs) and odds ratios (ORs), with 95% confidence intervals (CIs) reported. In the presence of heterogeneity, as indicated by the statistical tests, a random-effects model was employed; otherwise, a fixed-effect model was utilized to ensure accurate and reliable data synthesis.

2.7. Heterogeneity Testing

Potential sources of heterogeneity were anticipated to include variability in follow-up duration, tumor burden (categorized by size), surgical extent of the thyroidectomy, and differences in the comprehensiveness of the CND. Heterogeneity was assessed using Cochran’s Q test and the I² statistic, where a p-value of <0.05 from Cochran’s Q test indicated significant heterogeneity, and I² values of 25%, 50%, and 75% represented mild, moderate, and high heterogeneity, respectively.⁹ Subgroup and sensitivity analyses were conducted to further explore and address this heterogeneity.

2.8. Study Risk of Bias Assessment

The risk of bias was evaluated using the Cochrane Risk of Bias Tool, which assesses seven domains: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective reporting, and other biases.¹⁰ Each domain was categorized as having a low, unclear, or high risk of bias. Publication bias was assessed using funnel plots and the fail-safe N test, with the trim-and-fill method applied to adjust for any detected bias.¹¹

2.9. Quality of Evidence Assessment

The certainty of evidence was evaluated using the GRADE approach, which considers domains such as risk of bias, inconsistency, indirectness, imprecision, and publication bias for downgrading, and large effect sizes, dose-response gradients, and all plausible residual confounding for upgrading.¹² Based on these domains, the overall quality of evidence was rated as high, moderate, low, or very low.

3. Results

3.1. Study Selection

Database searches identified 720 records. After removing 178 duplicates, 542 records underwent title and abstract screening. Of these, 316 records were excluded. Subsequently, 226 full-text articles were assessed for eligibility, resulting in the inclusion of 7 studies in the meta-analysis. The study selection process is detailed in the PRISMA flowchart (Figure 1).

Figure 1.

PRISMA Flowchart of Study Inclusion and Exclusion

3.2. Study Characteristics

Seven RCTs, published between 2015 and 2025, were included. All studies evaluated pCND in patients with clinically node-negative papillary thyroid carcinoma (cN0 PTC). The total cohort comprised 1,484 patients (intervention group: n=777; control group: n=707). Key study characteristics are summarized in Table 2.

Table 2.

Characteristics of Included Studies

Study-year	Country	Patients(I/C)	Age, years(I/C)	Male, n (%)	Tumor size, mm(I/C)	Extent of pCND	Follow-up, months
Lee DY-2015	Korea	153/104	52.3±2.3/51.6±3.4	91(35.4)	17.0±12.0/16.0±14.0	NR	NR
Viola D-2015	Italy	93/88	45.7±14.6/43.5±13.2	46(25.4)	16.0±8.0/16.0±9.0	Bilateral	59.4±7.1
Sippel RS-2020	USA	30/30	50.1±2.4/46.1±2.5	13(21.7)	19.1±2.1/24.5±2.6	Ipsilateral	12.0±0.0
Kim BY-2020	Korea	82/82	48.5±9.4/47.9±9.1	54(32.9)	6.8±2.3/6.0±1.9	Ipsilateral	73.4±12.1
Ahn JH-2022	Korea	50/51	53.6±8.8/51.8±10.0	24(23.8)	10.0±4.0/11.0±6.0	Ipsilateral/Bilateral	46.6±9.1
Yuan Q-2023	China	288/282	NR	NR	17.5±11.7/18.5±11.3	Bilateral	60.0±5.7
Papini P-2025	Italy	81/70	45.0±14.3/43.9±12.8	35(23.2)	14.7±7.3/16.6±9.1	Bilateral	154.8±24.0

Abbreviations: I/C: Intervention/Control; NR: Not reported.

Table note: 1. Values are expressed as mean ± standard deviation (SD) unless otherwise indicated.

2. With the exception of Kim BY-2020, which utilized hemithyroidectomy for PTMC, all included studies performed TT for patients with PTC.

The mean age of participants ranged from 44 to 53 years, with a female predominance. Most tumors were classified as T1-T2 stage, with mean diameters ranging from 6 mm to 18 mm. One study focused exclusively on papillary thyroid microcarcinoma (PTMC, Kim BY-2020).

In the intervention groups, patients underwent total thyroidectomy (TT) or hemithyroidectomy with pCND (Kim BY-2020). Control groups underwent thyroidectomy alone. The extent of pCND varied: two studies performed ipsilateral dissection, three performed bilateral dissection, and two used a strategy determined by intraoperative findings. All procedures employed an open surgical approach. Follow-up duration ranged from 12 to over 150 months.

3.3. Primary Outcomes

For recurrence/persistence, the pooled analysis showed no statistically significant difference between groups (OR 1.0857, 95% CI 0.5694 - 2.0701; p = 0.8028). No heterogeneity was observed (I² = 0%; p = 0.7968).

In contrast, LNM was detected significantly more frequently in the pCND group (OR 7.4259, 95% CI 3.6721 - 15.0172; p < 0.001), with low heterogeneity (I² = 8%; p = 0.3388). (Figure 2).

Figure 2.

Forest plots of meta-analysis for five clinical outcomes. (A) Recurrence/persistence; (B) LNM; (C) HPT; (D) LNP; (E) Complications. The analysis is based on the Mantel-Haenszel (MH) method. Blue squares represent individual study effects, and black diamonds represent pooled odds ratios (OR)

3.4. Secondary Outcomes

For HPT, the pooled OR was 1.2530 (95% CI 0.5273 - 2.9778; p = 0.6095) with substantial heterogeneity (I² = 74%; p = 0.0093). LNP was not significantly different between groups (OR 0.8742, 95% CI 0.3690 - 2.0713; p = 0.7601), with no heterogeneity (I² = 0%; p = 0.5545). Although overall complications were not significantly different between groups, a consistent trend toward increased postoperative morbidity was observed in the pCND group (OR 1.5493, 95% CI 0.9027 - 2.6591; p = 0.1122), with moderate heterogeneity (I² = 64%; p = 0.0109).

3.5. Heterogeneity Source

Sensitivity analyses indicated that the pooled estimate for recurrence/persistence was influenced by the exclusion of one study (Kim BY-2020). Estimates for HPT were sensitive to the exclusion of two studies (Viola D-2015 and Lee DY-2015), while the estimate for LNP was sensitive only to the exclusion of Viola D-2015 (Figure 3).

Figure 3.

Sensitivity Analysis for Robustness Assessment of Meta-Analytic Results. (A) Recurrence/persistence; (B) LNM; (C) HPT; (D) LNP; (E) Complications. Each panel illustrates the impact of omitting individual studies on the pooled odds ratio (OR) to evaluate the stability of the findings

Subgroup analyses were performed for LNM, HPT, LNP, and Complications according to surgical extent (ipsilateral vs. bilateral pCND), timing, and pathology type (Supplementary Figures S1-S4). Heterogeneity estimates varied across these subgroups. For HPT, substantial heterogeneity was observed in the overall analysis (I² = 74%). This heterogeneity was absent in the subgroup of studies performing ipsilateral pCND (I² = 0.0%). Similarly, for overall complications, the overall heterogeneity was I² = 67%, which was reduced in subgroups defined by surgical extent (bilateral pCND: I² = 18.5%; ipsilateral pCND: I² = 0.0%).

For several prespecified subgroup factors, heterogeneity could not be meaningfully assessed because the included studies were concentrated within a single subgroup category.

3.6. Publication Bias

For the outcome of LNM, the funnel plot appeared symmetrical, with a fail-safe number of 31. Trim-and-fill analysis imputed two potentially missing studies yielded an adjusted OR of 11.7533 (95% CI 5.36 - 25.75; p < 0.001). For complications, the funnel plot was also symmetrical, with a fail-safe number of 15; after imputation of two studies, the adjusted OR was 1.9291 (95% CI 1.1089 - 3.3559; p = 0.0200). (Figures 4 and 5).

Figure 4.

Funnel plots for assessing publication bias across five outcomes. (A) Recurrence/persistence; (B) LNM; (C) HPT; (D) LNP; (E) Complications. The vertical dashed line represents the pooled effect size, and the diagonal lines indicate the 95% confidence intervals (CI)

Figure 5.

Funnel plots with trim and fill analysis for assessing outcome effects (A) Recurrence/persistence; (B) LNM; (C) HPT; (D) LNP; (E) Complications. Filled circles represent observed studies, while open circles indicate imputed studies used to adjust for potential publication bias

3.7. Risk of Bias

Assessment using the Cochrane Risk of Bias tool indicated that most studies had a low risk of bias for random sequence generation, allocation concealment, and blinding of outcome assessment. The risk of bias for blinding of participants and personnel was frequently rated as unclear. (Figures 6 and 7).

Figure 6.

Risk of bias graph

Figure 7.

Risk of Bias Summary

3.8. Grade

The certainty of evidence for all outcomes was assessed using the GRADE framework. The ratings ranged from very low to high, with downgrading primarily due to imprecision and inconsistency.

For the recurrence/persistence, the evidence was rated as moderate certainty, downgraded for serious imprecision. For LNM, the evidence was rated as high certainty. In contrast, the evidence for HPT, LNP, and Complications was rated as low certainty, primarily due to inconsistency and imprecision. No outcome met criteria for upgrading. (Figures 8 and 9).

Figure 8.

Grade evidence profile. This table summarizes the quality of evidence for each outcome according to the GRADE framework, accounting for risk of bias, inconsistency, indirectness, imprecision, and publication bias

Figure 9.

Grade summary of Finding table. This Grade summary table provides a more intuitive visualization of the evidence quality for the 5 outcome measures

4. Discussion

The clinical equipoise regarding pCND in cN0 thyroid cancer centers on whether improved pathological staging translates to superior patient outcomes. This meta-analysis of RCTs highlights a clear dissociation between diagnostic and therapeutic efficacy. While pCND markedly increased the detection of occult LNM (OR 7.43; p<0.001),¹³ it did not reduce rates of recurrence/persistence (OR 1.09).^14-16 This indicates that pCND primarily identifies indolent, microscopic nodal disease, underscoring its role in prognostic stratification rather than direct therapeutic intervention.^17-19

This staging advantage incurs a safety trade-off. Although the increase in overall complications was not statistically significant (OR 1.55, p=0.11), the consistent trend toward higher morbidity—predominantly HPT—remains a material concern.^20,21 The substantial heterogeneity in HPT outcomes (I²=74%) suggests this risk is highly context-dependent, likely influenced by parathyroid anatomical vulnerability, surgical expertise, and postoperative care.^19,22

By exclusively synthesizing RCT data, this analysis provides a robust assessment of pCND’s risk-benefit profile, minimizing selection bias. Given the lack of demonstrable therapeutic benefit and the potential for increased surgical morbidity, our findings advocate for the selective rather than routine use of pCND. Decisions should be individualized, weighing patient-specific risk factors and the need for precise staging against surgical risks. Despite limitations such as a modest number of included RCTs and heterogeneous safety reporting, and the fact that variations in surgical extent across included trials may limit the direct comparability of pooled estimates, this analysis establishes pCND primarily as a prognostic tool, guiding its rational integration into personalized thyroid cancer management. Future larger, multicenter RCTs with extended follow-up are warranted to standardize these outcomes.

5. Conclusion

This meta-analysis of RCTs suggests that pCND in cN0 thyroid cancer may increase the detection of occult LNM, thereby providing additional pathological staging information. In the currently available randomized data, however, this staging-related benefit is not accompanied by clear evidence of reduced recurrence/persistence, and it is associated with a consistent trend toward increased postoperative morbidity, particularly HPT. Because recurrence/persistence ascertainment and reporting were limited across studies, these findings should be interpreted with caution. Overall, the present evidence does not demonstrate a clear therapeutic advantage for pCND and instead suggests that its principal contribution, where present, may lie in staging rather than treatment effect. Accordingly, these results should not be taken as support for routine use, and any use of pCND is best considered on a case-by-case basis, contextualized by patient characteristics and surgeon expertise, and following a careful discussion of the potential risks and uncertain benefits.

Supplemental Material

Supplemental Material - Prophylactic Central Lymph Node Dissection Versus Thyroidectomy Alone in Clinically Node-Negative Thyroid Cancer: A Systematic Review and Meta-Analysis

Supplemental Material for Prophylactic Central Lymph Node Dissection Versus Thyroidectomy Alone in Clinically Node-Negative Thyroid Cancer: A Systematic Review and Meta-Analysis by Xianfeng Zhou, and Junhong Jiang in Ear, Nose & Throat Journal.

Footnotes

Acknowledgments

The authors gratefully acknowledge the technical support and professional guidance provided by Knowledge-Vision Co., Ltd. during this research.

ORCID iD

Xianfeng Zhou

Author Contributions

X.Z.: Investigation, Data Collection, Validation, Interpretation. J.J.: Formal Analysis, Visualization, Writing - Review & Editing. All authors have read and approved the final version of the manuscript.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

All raw data and code are available upon request.*

Institutional Review Board Statement

This study is a systematic review and meta-analysis that utilized exclusively data extracted from previously published research. As the research did not involve direct interaction with human subjects or access to any individual-level confidential or identifiable personal data, it was exempt from requiring approval from an Institutional Review Board (IRB) or Ethics Committee. This exemption is in accordance with standard ethical guidelines for secondary data synthesis, such as those outlined in the National Health Commission of China’s “Ethical Review Measures for Life Sciences and Medical Research Involving Humans” (Article 32), which states that ethical review is not required for research utilizing publicly available, anonymized aggregate data. All original studies included in this analysis were conducted under their own approved ethical protocols, which included informed consent from participants.

Supplemental Material

Supplemental material for this article is available online.

References

Adam

Goffredo

Youngwirth

Scheri

Roman

Sosa

. Same thyroid cancer, different national practice guidelines: When discordant American Thyroid Association and National Comprehensive Cancer Network surgery recommendations are associated with compromised patient outcome. Surgery. 2016;159(1):41-50. doi:10.1016/j.surg.2015.04.056.

Carty

Cooper

Doherty

, et al. Consensus statement on the terminology and classification of central neck dissection for thyroid cancer. Thyroid. 2009;19(11):1153-1158. doi:10.1089/thy.2009.0159.

Wang

Xiao

Pan

, et al. The effectiveness and safety of prophylactic central neck dissection in clinically node-negative papillary thyroid carcinoma patients: A meta-analysis. Front Endocrinol (Lausanne). 2022;13:1094012. doi:10.3389/fendo.2022.1094012.

Zheng

Chen

, et al. Is prophylactic central neck dissection necessary for patients with clinically node-negative papillary thyroid microcarcinoma? A follow-up study of more than 10 years. Front Endocrinol (Lausanne). 2025;16:1597661. doi:10.3389/fendo.2025.1597661.

Mao

Chen

, et al. Long-term impact of prophylactic central neck dissection in non-invasive classic papillary thyroid carcinoma. Eur J Surg Oncol. 2024;50(1):107305. doi:10.1016/j.ejso.2023.107305.

Wong

Lang

. The role of prophylactic central neck dissection in differentiated thyroid carcinoma: issues and controversies. J Oncol. 2011;2011:127929. doi:10.1155/2011/127929.

Yang

Han

Min

, et al. Prophylactic central neck dissection for cN0 papillary thyroid carcinoma: is there any difference between western countries and China? A systematic review and meta-analysis. Front Endocrinol (Lausanne). 2023;14:1176512. doi:10.3389/fendo.2023.1176512.

Haugen

Alexander

Bible

, et al. American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid. 2016;26(1):1-133. doi:10.1089/thy.2015.0020. 2015.

Turner

Davey

Clarke

Thompson

Higgins

. Predicting the extent of heterogeneity in meta-analysis, using empirical data from the Cochrane Database of Systematic Reviews. International journal of epidemiology. 2012;41(3):818-827. doi:10.1093/ije/dys041.

10.

Higgins

Thompson

Deeks

Altman

. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557-560. doi:10.1136/bmj.327.7414.557.

11.

Peters

Sutton

Jones

Abrams

Rushton

. Contour-enhanced meta-analysis funnel plots help distinguish publication bias from other causes of asymmetry. Journal of clinical epidemiology. 2008;61(10):991-996. doi:10.1016/j.jclinepi.2007.11.010.

12.

Khan

Agarwal

Arshad

, et al. Intravascular imaging guided versus coronary angiography guided percutaneous coronary intervention: systematic review and meta-analysis. BMJ. 2023;383:e077848. doi:10.1136/bmj-2023-077848.

13.

Ahn

Kwak

Yoon

, et al. A prospective randomized controlled trial to assess the efficacy and safety of prophylactic central compartment lymph node dissection in papillary thyroid carcinoma. Surgery. 2022;171(1):182-189. doi:10.1016/j.surg.2021.03.071.

14.

Kim

Choi

Kim

Jeong

Chung

Son

. Randomized trial of prophylactic ipsilateral central lymph node dissection in patients with clinically node negative papillary thyroid microcarcinoma. European archives of oto-rhino-laryngology. 2020;277(2):569-576. doi:10.1007/s00405-019-05702-3.

15.

Papini

Rossi

Matrone

, et al. Prophylactic central neck dissection in clinically node-negative papillary thyroid carcinoma: 10-year impact on surgical and oncologic outcomes. Surgery. 2025;181:109258. doi:10.1016/j.surg.2025.109258.

16.

Sippel

Robbins

Poehls

, et al. A Randomized Controlled Clinical Trial: No Clear Benefit to Prophylactic Central Neck Dissection in Patients With Clinically Node Negative Papillary Thyroid Cancer. Annals of surgery. 2020;272(3):496-503. doi:10.1097/SLA.0000000000004345.

17.

Bakkar

Chorti

Papavramidis

, et al. Verifying the oncologic rationale of prophylactic central compartment neck dissection in the management of papillary thyroid carcinoma using a pathologic spectrum of nodal metastases characteristics. A Prospective Comparative study. Endocrine. 2025;89(1):119-124. doi:10.1007/s12020-025-04209-8.

18.

Viola

Materazzi

Valerio

, et al. Prophylactic central compartment lymph node dissection in papillary thyroid carcinoma: clinical implications derived from the first prospective randomized controlled single institution study. The Journal of clinical endocrinology and metabolism. 2015;100(4):1316-1324. doi:10.1210/jc.2014-3825.

19.

Yuan

Yang

, et al. Prophylactic Central Neck Dissection Based on Preoperative Imaging and Intraoperative Surgeon’s Palpation Versus Total Thyroidectomy Alone for Papillary Thyroid Cancer. The Journal of surgical research. 2023;290:126-132. doi:10.1016/j.jss.2023.03.035.

20.

Zhao

Luo

Zhou

Dai

Zhu

. Evaluating the effectiveness of prophylactic central neck dissection with total thyroidectomy for cN0 papillary thyroid carcinoma: An updated meta-analysis. European journal of surgical oncology. 2017;43(11):1989-2000. doi:10.1016/j.ejso.2017.07.008.

21.

Salem

Bergenfelz

Nordenström

Almquist

. Central lymph node dissection and permanent hypoparathyroidism after total thyroidectomy for papillary thyroid cancer: population-based study. The British journal of surgery. 2021;108(6):684-690. doi:10.1002/bjs.12028.

22.

Liu

Sosa

Grogan

, et al. Variation of thyroidectomy-specific outcomes among hospitals and their association with risk adjustment and hospital performance. JAMA surgery. 2018;153(1):e174593. doi:10.1001/jamasurg.2017.4593.

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