Limiting Complete Thyroidectomy Post Hemithyroidectomy, Total Thyroidectomy May Reduce Overtreatment in Thyroid Cancer

Retrospective results found considering conservative initial surgery options can reduce overtreatment for patients with thyroid cancer.

Overtreatment may be reduced for patients with thyroid cancer by limiting completion thyroidectomy after hemithyroidectomy (CTx-HTx), total thyroidectomy (TTx), and revision surgery after TTx (RTx-TTx), according to a retrospective study published in Medical Science Monitor.

Additionally, considering conservative initial surgery options, particularly when there are no definitive TTx indications, may help reduce exceedingly high numbers of unnecessary CTx-HTx, TTx, and RTx-TTx surgeries.

The retrospective data show that 23.3% of patient specimens had malignancies in the CTx-HTx cohort, and univariate and multivariate analyses found no predictors of malignancy. Malignancies were reported in 75.0% and 13.3% of the initial and contralateral lobes in the TTx cohort, and TTx was identified as an independent risk factor for hypocalcemia through multivariable analysis.

Patients undergoing conventional open thyroidectomy between January 2014 and October 2019 (n = 1619) were reviewed and disaggregated into 3 groups. One group (n = 60) received HTx whose HTx material resulted as differentiated thyroid cancer (DTC), warranting performance of CTx. This group consisted of a malignant (CTx-M) and a benign (CTx-B) patient subgroup.

The second group (n = 60) consisted of randomly selected age-matched patients who underwent TTx and did not require revision surgery. Patients were excluded from this group if they had a history of thyroid surgery, had undergone TTX for reasons other than malignancy suspicion, had conclusive fine-needle aspiration cytology (FNAC) result for malignancy, had thyroid malignancies with adjacent tissue invasion, had central or lateral neck dissection, or had simultaneously undergone parathyroidectomy.

The third group (n = 47) consisted of patients with recurrent or residual tissue after initial TTx requiring RTx-TTx re-operation. Patients were excluded from this group if they had a toxic or retrosternal goiter, thyrotoxicosis, or conclusive FNAC result for malignancy.

The coprimary end points were determining malignancy rates in CTx specimens from patients undergoing CTx-HTx and determining factors to predict thyroid malignancies. The secondary end point was to compare CTx-HTx, TTx, and RTx-TTx surgeries by pathological results and complications after procedure.

Malignant pathology results for the main specimen side, defined as hemithyroidectomy specimens for the CTx-HTx group and the FNAC performed side for both TTx and RTx-TTx sides, were 100%, 75.0%, and 51.3% for the CTx-HTx, TTx, and RTx-TTx groups, respectively (P < .001). For the opposite side, 23.3%, 13.3%, and 23.4% malignancy rates were observed in each group (P = .295).

Additionally, TTx correlated with significantly decreased calcium levels after procedure compared with CTx-HTx (CTx-HTx, –0.73±0.61, TTx, –1.25±0.65; P < 0.001). Furthermore, hospital stays of 2 days or longer were reported within the TTX group than the CTx-HTx group (28.3% vs 10.0%; P < .025).

Transient hypocalcemia was observed in 10% of CTx-HTx patients, 26.7% of TTx patients, and 17.0% of RTx-TTx patients (P < .058). Furthermore, permanent hypocalcemia occurred in 1.7% and 4.3% of TTx and RTx-TTx patients, respectively (P < .257).

“In conclusion, the malignancy rate in CTx specimens performed after HTx was 23.3%, in the opposite lobe of TTx specimens it was 13.3%, and in revision thyroid surgery specimens performed after [TTx] it was 23.4%, indicating an alarmingly high frequency of unnecessary CTx, TTx, and revision thyroid surgery,” coauthors Abbas Aras, MD, of the Department of General Surgery, Van YYU Medical Faculty, and Ali R. Karayıl, MD, of the General Surgery Unit, SBU Van Training and Research Hospital, both in Van, Turkey, concluded in the journal. “The number of patients being overtreated can be reduced by choosing more conservative surgeries as an initial surgery, especially if there is no clear indication for TTx, and also by narrowing down the indications that necessitate CTx after HTx, TTx, and revision thyroid surgery.”

Reference

Aras A, Karayıl AR. Optimal surgical approaches for thyroid cancer: a comparative analysis of efficacy and complications. Med Sci Monit. 2024;30:e942619. Published July 8, 2024. doi:10.12659/MSM.942619