Extent of Surgery for Follicular Thyroid Carcinoma

Abstract

Objectives To examine the association between the extent of surgery and overall survival in follicular thyroid cancer (FTC) patients. Study Design Retrospective analysis of the National Cancer Database (NCDB). Methods Patients who underwent surgical intervention for FTC from 2004 to 2015 were selected. Patients were >18 years old, with tumor size 1–4 cm, no other malignancies, and >0 follow up time. Patients were divided into two cohorts based on extent of surgery: lobectomy (≥1 lobe resected) and thyroidectomy (total or near total resection). Pearson's chi‐squared analysis was used to compare cohorts. Kaplan–Meier survival and Cox hazards models were utilized to determine overall survival between two cohorts with p < 0.05 used for significance. Results A total of 6871 patients were identified with FTC, of which 1507 patients underwent lobectomy and 5364 patients underwent total thyroidectomy. There were no significant differences in patient demographics, comorbidity index, local spread, or tumor grade. Patients undergoing lobectomy had mean survival of 12.94 versus 12.71 years for those undergoing thyroidectomy. Extent of surgery was not associated with a significant difference in survival (5 years OS = 96% in lobectomy and 95.5% in total thyroidectomy, p = 0.08). Stratification by tumor grade resulted in no significant difference in survival between lobectomy and thyroidectomy. Conclusion Survival time was not significantly different in patients with more extensive resection of FTC. Level of Evidence 3 Laryngoscope, 133:993–999, 2023

Prognosis and influencing factors of follicular thyroid cancer

“…It has also been suggested that nodule size and histologic subtype are factors influencing prognosis, such that patients with nodules >4 cm and widely invasive FTC have a worse prognosis. Studies on the influence of surgical method on the prognosis of FTC patients do not have the same results, some believe that the prognosis of unilateral thyroidectomy is similar to that of total lobectomy, while others prefer a better prognosis for total lobectomy 3,16–20 . Therefore, the choice of surgical method by surgeons is still controversial.…”

“…Studies on the influence of surgical method on the prognosis of FTC patients do not have the same results, some believe that the prognosis of unilateral thyroidectomy is similar to that of total lobectomy, while others prefer a better prognosis for total lobectomy. 3 , 16 , 17 , 18 , 19 , 20 Therefore, the choice of surgical method by surgeons is still controversial.…”