Efficacy of Carbon Nanoparticles for Parathyroid Glands Protection During Total Thyroidectomy and Bilateral Central Lymph Nodes Dissection for Thyroid Cancer: A Systematic Review and Meta-Analysis

Xuchen Huang^1,4, Houshen Li², Xuhua Hu³, Tongbo Yi¹

¹Department of Thyroid and Breast Surgery, Taizhou Clinical Medical School of Nanjing Medical University (Taizhou People’s Hospital), Taizhou, Jiangsu Province, China - ²Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, Kings College London, London, UK - ³The Second Department of General Surgery, Hebei Medical University Fourth Affiliated Hospital, Shijiazhuang, Hebei Province, China - ⁴Department of Breast Center, Hebei Medical University Fourth Affiliated Hospital, Shijiazhuang, Hebei Province

Introduction: Parathyroid injury is a common surgical complication of total thyroidectomy (TT) and bilateral central lymph nodes dissection (BCLND) for thyroid cancer (TC). Effects of carbon nanoparticles (CN) in protecting parathyroid during TT and BCLND were revealed by many studies, while ineffectiveness of CN was also reported. We conducted this meta-analysis to find out the potential effects of CN in protecting parathyroid during TT and BCLND for patients with TC.

Methods: This study was registered at PROSPERO (registration number CRD42020212973). Studies were searched from databases, including PubMed, EMBASE, Web of Science and Cochrane Library. Outcomes were extracted from studies coincident with predetermined criteria. The outcomes were then pooled and compared to find out the potential advantages of CN.

Results: A total of six studies were included into the final meta-analysis. Significantly lower rates of accidental parathyroid resection and transient hypoparathyroidism were found in CN group than control group [risk ratio (RR) = 0.35, 95% CI 0.19 to 0.63, P < 0.01; RR = 0.31, 95% CI 0.14 to 0.70, P < 0.01, respectively]. The permanent hypoparathyroidism rate of the CN group was lower than that of the control group, while the difference was not significant (RR = 0.59, 95% CI 0.22 to 1.59, P = 0.30).

Conclusion: CN can facilitate parathyroid protection from accidental resection in TC patients treated with TT and BCLND. Moreover, it is also helpful in significantly lowering the rate of transient hypoparathyroidism, rather than permanent hypoparathyroidism. More prospective studies are needed to confirm our findings.