Comparison of surgical strategies in the treatment of low-risk differentiated thyroid cancer

Abstract

Context Increasing diagnostic sensitivity in the detection of thyroid cancer has led to uncertainties in the optimal surgical approach of the smaller, low risk tumors. Current ATA guidelines consider lobectomy safe between 1 and 4 cm, while ETA advocates for primary total thyroidectomy to avoid reoperation, as final risk stratification is based on the histological results. Objective Our aim was to compare the differences in outcomes that are potentially achievable with adherence to the different guidelines, and also to examine the predictive value of clinical parameters on the incidence of postoperative risk factors. Methods We performed a retrospective cohort database analysis to identify the different surgical outcomes (based on postoperative risk factors) using ATA and ETA guidelines; the hypothetical rate of completion thyroidectomy when ATA or ETA recommends lobectomy; the accuracy of our preoperative evaluation; the utility of preoperative findings in predicting the optimal surgical strategy using binary logistic regression. Results Out of 248 patients, 152 (ATA) and 23 (ETA) cases would have been recommended for initial lobectomy. Following the guidelines, a postoperative risk factor would have been present in 61.8, and 65.2% of the cases, respectively. Except for angioinvasion, tumor size was not a significant predictor for the presence of postoperative risk factors. Conclusion Current pre-operative criteria are inadequate to accurately determine the extent of initial surgery and our postoperative findings verify the frequent need for completion thyroidectomy using both guidelines. As a consequence, in the absence of effective pre-operative set of criteria, we advocate primary total thyroidectomy in most cases.

Associated Complications and survival rate after thyroid cancer operation

“…In our study Survival time regarding the tumor stage, was (58.79) months for stage I, and then it decreased to (23.36) months for statistically significant stage IV (p < 0.001) which consistent to previous study that early detection of thyroid cancer better prognosis [37]. December 2023 ,Volume 25, Issue 2 According to the guideline of American Thyroid Association of surgeons the indication of total thyroidectomy (TT) should be tumor size, histopathologic report and radiologic findings [38]. In our study, 81.9% of patients underwent TT which is higher than what was published by Alawadhi et al (2020) and less than that of Alzahrani et al (2017) [28,39].…”

How good is lobectomy for the Turkish population with papillary thyroid cancer? A clinicopathological evaluation

“…In the study by Kiss et. al., it has been reported that tumor size, except for angioinvasion, was not a significant predictor for the presence of postoperative risk factors (20). In another study evaluating 906 patients with PTC and pathologic N1 metastasis, it has been reported that total thyroidectomy was associated with better survival outcomes compared to lobectomy in patients with more than five lymph node metastases and metastatic lymph node sizes between 2-5 mm (29).…”

“…In a recent study including 152 patients meeting the criteria for lobectomy according to the ATA guidelines and of whom 72.4% underwent total thyroidectomy, it has been reported that 61.8% of the patients had high-risk factors detected in postoperative evaluation. Accordingly, the authors have suggested that preoperative staging was inadequate in identifying those factors and recommended a more frequent use of total thyroidectomy (20). In a study by Wouter et al involving 287 lobectomy-eligible patients with tumor sizes between 1-4 cm and without CLND, 43% of the patients required completion thyroidectomy based on lobectomy pathology (16).…”

“…Consequently, there is no consensus on treatment approaches that should be used for the low-risk patient group. Since optimal treatment should aim for the lowest possible rates of LRR and complications, the selection of an individualized treatment considering patient-related factors as well as local surgical practices becomes crucial (20,21). The aim of this study was to evaluate the feasibility of hypothetical lobectomy based on preoperative assessment and pathological outcomes in patients who had undergone total thyroidectomy in a Turkish thyroid cancer patient population.…”