Surgical Management of Low-/Intermediate-Risk Node Negative Thyroid Cancer: A Single-Institution Study Using Propensity Matching Analysis to Compare Thyroid Lobectomy and Total Thyroidectomy

Matsuura, Danielli; Yuan, Amy; Harris, Victoria; Shaha, Ashok R.; Tuttle, R. Michael; Patel, Snehal G.; Shah, Jatin P.; Ganly, Ian

doi:10.1089/thy.2021.0356

Cited by 25 publications

(15 citation statements)

References 27 publications

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“…Traditional thyroid surgery can effectively remove the lesions and has a significant clinical effect. However, this surgical method has the disadvantages of large trauma and large intraoperative blood loss [ 12 , 13 ]. Afterwards, there will be obvious scars, which will affect the patient's physical appearance to a certain extent and increase the patient's psychological burden.…”

Section: Introductionmentioning

confidence: 99%

Advantages of Small Incision Surgery in Thyroid Tumors

Feng¹,

Feng²,

Diao³

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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Objective. Thyroid tumor is a common thyroid disease, and the incidence of complications after traditional thyroid surgery is high, which seriously affects the prognosis of patients. With the development of minimally invasive techniques, small incision surgery has a positive impact on changing the traditional thyroid surgery treatment. However, the gap between small incision surgery and traditional thyroid surgery is unclear, so this meta-analysis was used to evaluate its application value. Methods. Searching English biomedical databases, including PubMed and Science Network and Chinese major biomedical databases, including CNKI, Wanfang, and Weipu. The keywords of the searched articles are as follows: small incision surgery, traditional thyroid surgery, thyroid tumor treatment, clinical efficacy of thyroid tumor, and surgical treatment, and these keywords are searched individually or in combination to track relevant systematic reviews and literature meta-analysis, and conduct other studies. The retrieval period is from the establishment of the database to January 2022. After extracting the article data, the patients were divided into small incision surgery group and traditional thyroid surgery group due to different intervention methods. The Cochrane risk of bias tool was used to assess the quality of the included literature, and RevMan 5.30 was used for meta-analysis. Results. A total of 9 articles met the inclusion criteria. There were 369 patients with small incision surgery and 364 patients with traditional thyroid surgery. Compared with traditional thyroid surgery, patients treated with small incision surgery had significant short hospitalization time (MD −2.72, 95% CI (−3.32, −2.12)), less amount of bleeding (MD −15.52, 95% CI (−20.40, −10.65)), short incision length (MD −12.73, 95% CI (−16.29, −9.17)), lower VAS score (MD −2.58, 95% CI (−4.08, −1.08)), and less complications (RR 0.30, 95% CI (0.21, 0.44)). Conclusion. Compared with traditional thyroid surgery, the results show that small incision surgery can shorten the hospital stay of patients with thyroid tumor, reduce the length of incision, reduce the amount of bleeding and the occurrence of complications, reduce postoperative pain, and have a positive effect on postoperative survival of patients.

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Section: Introductionmentioning

confidence: 99%

Advantages of Small Incision Surgery in Thyroid Tumors

Feng¹,

Feng²,

Diao³

et al. 2022

Evidence-Based Complementary and Alternative Medicine

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“…Age, sex, histology, RAI therapy, ATA risk class, and TNM stage were selected as PS matching criteria to reduce potential bias and control possible confounders. After PS matching, no significant differences between TL and TT for OS, DSS, and RFS were found [30]. Both papers confirm that TL may be a therapeutic option for low-risk T1T2 patients.…”

Section: Fig 1 the Difference Between Lobectomy And Loboisthmectomymentioning

confidence: 67%

Lobo-isthmectomy in the management of differentiated thyroid cancer

et al. 2023

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We have recently witnessed a rapid increase in the incidence of differentiated thyroid carcinoma (DTC), particularly low and very low-risk papillary thyroid carcinoma. Simultaneously, the number of cancer-related deaths has remained stable for more than 30 years. Such an indolent nature and long-term survival prompted researchers and experts to an ongoing discussion on the adequacy of DTC management to avoid, on the one hand, the overtreatment of low-risk cases and, on the other hand, the undertreatment of highly aggressive ones.The most recent guidelines of the American Thyroid Association (ATA GL) moved primary thyroid surgery in DTC towards a less aggressive approach by making lobectomy an option for patients with intrathyroidal low-risk DTC tumors up to 4 cm in diameter without evidence of extrathyroidal extension or lymph node metastases. It was one of the key changes in DTC management proposed by the ATA in 2015.Following the introduction of the 2015 ATA GL, the role of thyroid lobectomy in DTC management has slowly become increasingly important. The data coming from analyses of the large databases and retrospective studies prove that a less extensive surgical approach, even if in some reports it was related to a slight increase of the risk of recurrence, did not show a negative impact on disease-specific and overall survival in T1T2N0M0 low-risk DTC. There is no doubt that making thyroid lobectomy an option for low-risk papillary and follicular carcinomas was an essential step toward the de-escalation of treatment in thyroid carcinoma.This review summarizes the current recommendations and evidence-based data supporting the necessity of de-escalation of primary thyroid surgery in low-risk DTC. It also discusses the controversies raised by introducing new ATA guidelines and tries to resolve some open questions.

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“…4 In our previous reports, no advantages of TT over lobectomy for intermediate-risk PTC were found with respect to RFS or disease-specific survival rate, which may not be entirely surprising because similar findings have been obtained in several previous studies. 14 A study by Matsuura et al 15 analyzed 3756 patients with lowintermediate-risk node-negative thyroid cancer and showed no significant differences between lobectomy and TT for RFS (10-year RFS, 99.5% vs 98.3; P = .08) after PSM for age, sex, histology, pT stage, RAI ablation, and ATA initial risk stratification. Adam et al 16 evaluated the National Cancer Database data of 61 775 patients with PTC, including 8%, 25%, and 1% of cases involving ETE, TNM, and distant metastasis, respectively, and showed that the extent of surgery was not independently associated with compromised survival.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Lobectomy vs Total Thyroidectomy for Intermediate-Risk Papillary Thyroid Carcinoma With Lymph Node Metastasis

Huang

et al. 2023

JAMA Surg

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ImportanceSurgical treatment of patients with papillary thyroid cancer (PTC) by either lobectomy or total thyroidectomy (TT) has long been a topic of debate, especially for patients with intermediate-risk PTC.ObjectiveTo compare recurrence-free survival (RFS) for patients with PTC and lymph node metastasis after lobectomy vs TT.Design, Setting, and ParticipantsThis retrospective cohort study included a review of patients with PTC treated from January 1, 2000, to December 31, 2017. Propensity score matching (PSM) was performed between patients treated with lobectomy and TT. This study involved a single institute in a cancer referral center. Enrolled were adult patients (aged 18-75 years) with unilateral PTC and ipsilateral clinical lateral neck metastasis (cN1b). Patients with the following characteristics were excluded: a lymph node yield less than 20, primary tumor size greater than 4 cm, gross extrathyroidal extension, metastatic lymph node size greater than 3 cm, and distant metastasis. Data analysis was performed from April 1 to April 30, 2022.ExposuresLobectomy and TT.Main Outcomes and MeasuresThe primary outcome was the association between extent of surgery and RFS, assessed using Cox proportional hazards regression models.ResultsA total of 946 patients with PTC (mean [SD] age, 37.0 [12.1] years, 630 female individuals [66.6%]) were analyzed. Lobectomy (624 [66.0%]) was negatively correlated with the frequencies of older age (≥65 years, 17 [2.7%]), female sex (393 [63.0%]), multifocality (132 [21.2%]), minor extrathyroidal extension (259 [41.5%]), number of metastatic lymph nodes (median [range], 9 [6-14] nodes), and radioactive iodine ablation (0). After PSM with treatment period and potential prognostic factors (age, sex, primary tumor size, multifocality, minor extrathyroidal extension, number of lymph node metastases and lymph node ratio), 265 pairs of patients were available for analysis. After a median (range) follow-up of 60 (9-150) months in the lobectomy group and 58 (8-161) months in the TT group, 21 (7.9%) and 17 (6.4%) structural recurrences were identified in the lobectomy and TT groups, respectively. Lobectomy was not associated with significantly compromised 5-year RFS rate (lobectomy, 92.3% vs TT, 93.7%; adjusted hazard ratio, 1.10; 95% CI, 0.58-2.11; P = .77). Power analysis indicated that the test had 90% power to detect a more than 4.9% RFS difference. No significant difference in RFS was observed between patients treated with TT and radioactive iodine ablation (n = 75) and their counterparts (adjusted hazard ratio, 0.59; 95% CI, 0.14-2.41; P = .46).Conclusions and RelevanceResults of this cohort study suggest that patients with PTC and lymph node metastasis had a similar RFS after lobectomy vs those who had TT. If radioactive iodine ablation is not going to be performed, lobectomy may be an effective alternative option.

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Surgical Management of Low-/Intermediate-Risk Node Negative Thyroid Cancer: A Single-Institution Study Using Propensity Matching Analysis to Compare Thyroid Lobectomy and Total Thyroidectomy

Cited by 25 publications

References 27 publications

Advantages of Small Incision Surgery in Thyroid Tumors

Advantages of Small Incision Surgery in Thyroid Tumors

Lobo-isthmectomy in the management of differentiated thyroid cancer

Comparison of Lobectomy vs Total Thyroidectomy for Intermediate-Risk Papillary Thyroid Carcinoma With Lymph Node Metastasis

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