Extent of surgery for low-risk thyroid cancer in the elderly: Equipoise in survival but not in short-term outcomes

Zambeli-Ljepovic, Alan; Wang, Frances; Dinan, Michaela A.; Hyslop, Terry; Stang, Michael T.; Roman, Sanziana A.; Sosa, Julie Ann; Scheri, Randall P.

doi:10.1016/j.surg.2019.05.035

Cited by 16 publications

(7 citation statements)

References 22 publications

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“…Supporters of TT underline the lower risk of recurrence, possibility of thyroglobulin administration during follow-up, and use of I-131 for both diagnostic and therapeutic aims 36 . On the other hand, lobectomy has been preferred for its lower postsurgical morbidity and the absence of lifelong replacement therapy 23 , 24 , 37 . Moreover, supporters of lobectomy have stated that several studies found no difference in recurrence rates and that patients who develop recurrence can still be successfully treated without increasing disease-specific mortality 15 .…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have reported that thyroid lobectomy (TL) had a higher risk for recurrence compared to TT 9 , 21 , 22 . Furthermore, adverse surgical events, such as hypocalcaemia and recurrent laryngeal nerve injury, are more frequent and severe after TT than after lobectomy alone 23 , 24 . As confirmed by the latest ATA guidelines, accurate preoperative staging and risk evaluation is crucial to determine the proper surgical approach and post-surgical management 12 .…”

Section: Introductionmentioning

confidence: 99%

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Total thyroidectomy versus lobectomy: surgical approach to T1-T2 papillary thyroid cancer

Filippo

Giugliano

Tagliabue³

et al. 2020

Acta Otorhinolaryngol Ital

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SUMMARY The incidence of papillary thyroid carcinoma, which accounts for 80-90% of all thyroid cancers, has recently been increasing. The current study aimed to compare the oncological and functional outcomes of total thyroidectomy (TT) and thyroid lobectomy (TL). To this end, a retrospective single-centre cohort study involving a tertiary care institution was conducted. Data regarding demographics, clinicopathology and postoperative complications from 586 patients with papillary thyroid cancer treated in a single institution were collected. Cox proportional-hazards models were utilised to determine differences in outcomes stratified according to propensity score. Our data suggested no significant difference in the risk for locoregional recurrence or distant metastasis between TL and TT among patients with pT1-2 pN0 papillary carcinoma. TT plays an important role in improving prognosis among patients with metastatic lymph nodes in the central neck compartment (pN1a) (p = 0.001). Moreover, TT had significantly higher rates of postoperative hypocalcaemia and recurrent laryngeal nerve paralysis compared to TL (p < 0.001 and p = 0.02, respectively).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Total thyroidectomy versus lobectomy: surgical approach to T1-T2 papillary thyroid cancer

Filippo

Giugliano

Tagliabue³

et al. 2020

Acta Otorhinolaryngol Ital

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“…While surgical alternatives range from lobectomy/subtotal thyroidectomy for tumors not exceeding 4 cm to near total/total thyroidectomy with or without LN dissection for more advanced tumors, active surveillance without a surgical intervention is a reasonable option for very low risk patients with PTC [6]. Age, comorbidities and life expectancy should be considered when individualizing treatment, as total thyroidectomy for older adults with low risk PTC has been associated with higher incidence of complications and hospital readmissions [27]. In fact, a significant proportion of patients, specifically older individuals with low-risk tumors, may benefit from active surveillance without a surgical intervention.…”

Section: Current Standard Of Care For Dtcmentioning

confidence: 99%

Updates on the Management of Thyroid Cancer

2020

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The diagnostic modalities, stratification tools, and treatment options for patients with thyroid cancer have rapidly evolved since the development of the American Thyroid Association (ATA) guidelines in 2015. This review compiles newer concepts in diagnosis, stratification tools and treatment options for patients with differentiated thyroid cancer (DTC), medullary thyroid carcinoma (MTC) and anaplastic thyroid cancer (ATC). Newer developments apply precision medicine in thyroid cancer patients to avoid over-treatment in low risk disease and under-treatment in high risk disease. Among novel patient-tailored therapies are selective RET inhibitors that have shown efficacy in the treatment of MTC with limited systemic toxicity compared with non-specific tyrosine kinase inhibitors. The combination of BRAF and MEK inhibitors have revolutionized management of BRAF V600E mutant ATC. Several immunotherapeutic agents are being actively investigated in the treatment of all forms of thyroid cancer. In this review, we describe the recent advances in the diagnosis and management of DTC, MTC, and ATC, with an emphasis on novel treatment modalities.

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“…In this study, patients with pCLND were much older than the control group (mean age: 50.02 vs. 46.98), which meant that patients without pCLND had a higher probability of having comorbidities. However, as baseline comorbidities were not recorded in the SEER database, we could not conduct a fur- [31][32][33]. However, most of the present studies focused on recurrence-free survival or TCSS.…”

Section: Discussionmentioning

confidence: 97%

Long-Term Survival in Patients With Papillary Thyroid Cancer Who Did Not Undergo Prophylactic Central Lymph Node Dissection: A SEER-Based Study

Song

et al. 2022

World J Oncol

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Background:The role of prophylactic central lymph node dissection (pCLND) for papillary thyroid cancer (PTC) remains contentious, and the impact of pCLND on long-term patient outcomes is unclear. Methods:A retrospective analysis of data from the Surveillance, Epidemiology, and End Results (SEER) database was performed. Patients diagnosed with PTC who did not undergo pCLND between 2004 and 2015 were included in this study, and patients with pN0 PTC who underwent CLND were included as the control group. The researchers calculated the subdistribution hazard ratio (SHR) using the Fine-Gray model and the hazard ratio (HR) using the Cox proportional hazards regression to compare Thyroid cancer-specific survival (TCSS) and overall survival (OS) of the different groups.Results: A total of 38,205 T1-2cN0 PTC patients without pCLND were eligible for the study entry, and 24,157 patients with T1-2pN0 PTC patients who had received CLND were included as the control group. The actuarial 10-year TCSS and OS rates of patients without pCLND were 99.53% and 92.77%, respectively. Patients without pCLND had similar TCSS compared with the control group after adjusting for age, sex, race, tumor stage, multifocality, thyroid surgery, and radiation (SHR = 1.35, 95% CI: 0.95 -1.93). However, patients without pCLND had a significantly poorer OS than the control group (HR = 1.38, 95% CI: 1.26 -1.51).Conclusions: Patients without pCLND had similar TCSS compared with the control group after adjusting for confounders but had significantly poorer OS. Whether the OS disparities were attributed to pCLND or other factors still needs further study.

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Extent of surgery for low-risk thyroid cancer in the elderly: Equipoise in survival but not in short-term outcomes

Cited by 16 publications

References 22 publications

Total thyroidectomy versus lobectomy: surgical approach to T1-T2 papillary thyroid cancer

Total thyroidectomy versus lobectomy: surgical approach to T1-T2 papillary thyroid cancer

Updates on the Management of Thyroid Cancer

Long-Term Survival in Patients With Papillary Thyroid Cancer Who Did Not Undergo Prophylactic Central Lymph Node Dissection: A SEER-Based Study

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