Long-term results of surgical treatment of low-riskpapillary thyroid cancer

Abstract

The purpose of the workis to analyze the long-term results of surgical treatment of low-risk papillary thyroid cancer, taking into account the volume of surgical intervention at the Ukrainian Scientific and Practical Center of Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukraine for the period from 2015 to 2020. Materials and methods. The results of treatment of patients with papillary thyroid cancer in Ukrainian Scientific and Practical Center of Endocrine Surgery, Transplantation of Endocrine Organs and Tissues of the Ministry of Health of Ukraine for the period from 2015 to 2020 were analyzed. The cases (n = 178) consisted of operated patients with completed hemithyroidectomy (HTE) and central dissection (CD). The controls (n = 384) included patients with completed thyroidectomy (TE) and CD. The data on the presence or absence of relapses of papillary thyroid cancer during the follow-up period were evaluated using ultrasonic scanning of the neck in dynamics. The specific complications of surgical intervention were analyzed. The patients were examined by laryngologist before and after surgery. The indicators of electrolyte changes were monitored. The level of thyroid-stimulating hormone and the daily dose of levothyroxine sodium were analyzed. Results and discussion. In the cases consisted of 156 patients with the pT1a-b disease, relapses were observed in 5 (3.2 %). No relapses were observed in the pT2 group. In the controls, where TE with CD were performed, 4 (1.04 %) relapses of papillary cancer were observed in the long-term period out of 384 subjects. All relapses observed were in the form of locoregional metastasis. The number of postoperative transient laryngeal movement disorders when performing TE with systematic CD did not exceed 11.2 %, while when performing HTE with CD, such complications were decreased to 6.18 % as expected. There was no laboratory-scale decrease in calcium levels when performing HTE supplemented with CD. When performing TE with CD, a decrease in the level of Ca2+ ≤ 1.0 mmol/l was observed in 79 (20.5 %) of the patients, and 4 patients continued to calcium supplements in the future. In the cases, 24 of the patients (13.48 %) completely stopped taking levothyroxine sodium in the first year. The issue of the possibility of performing organ-preserving surgery in the category of the рТ2 disease remains debatable. In this study, the subgroup with the рТ2 category is not reliably significant (n = 22), although there is a general trend towards relapses and complications. Conclusions. Performing organ-preserving opera­tions in the form of hemithyroidectomy with mandatory lymph node dissections of the central group in patients with pT1a-bN0Mx, pT2N0Mx papillary thyroid cancer is a safer method of surgical treatment of papillary thyroid cancer compared to thyroidectomy. There was no significant difference in relapse rates between the groups (TE and HTE). It is possible to reduce the dose of levothyroxine sodium replacement therapy due to the functioning of residual fraction of the thyroid gland.