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

BMC Endocrine Disorders

Research

Kristóf Árvai¹  István Takács¹  Richárd Ármós¹  Barbara Kocsis-Deák¹  János Pál Kósa¹  Zsuzsanna Putz¹  Bálint Tobiás¹  Balázs Szili¹  Bence Bakos¹  Bernadett Balla¹  Magdolna Dank¹  Péter Lakatos¹  Henriett Pikó¹  András Kiss¹ 

[1] Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, 1082 Korányi S. u. 2/a, Budapest, Hungary;

关键词: Thyroid cancer;    Thyroid nodules;    Well differentiated thryoid cancer;    Surgery;   

DOI  :  10.1186/s12902-023-01276-8

 received in 2022-10-15, accepted in 2023-01-19,  发布年份 2023

来源: Springer

【 摘 要 】

ContextIncreasing 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.ObjectiveOur 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.MethodsWe 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.ResultsOut 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.ConclusionCurrent 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.

【 授权许可】

CC BY   
© The Author(s) 2023