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

BackgroundThe 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.MethodsA 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.ResultsSeven 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.ConclusionCurrent 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.