Abstract
Recently, the management of patients with low-risk differentiated non-medullary thyroid cancer (DTC), including papillary and follicular thyroid carcinoma subtypes, has been critically appraised, questioning whether these patients might be overtreated without a clear clinical benefit. The American Thyroid Association (ATA) guideline suggests that thyroid lobectomy (TL) could be a safe alternative for total thyroidectomy (TT) in patients with DTC up to 4 cm limited to the thyroid, without metastases. We conducted a meta-analysis to assess the clinical outcomes in patients with low-risk DTC based on the extent of surgery. The risk ratio (RR) of recurrence rate, overall survival (OS), disease-free survival (DFS) and disease specific survival (DSS) were estimated. In total 16 studies with 175,430 patients met the inclusion criteria. Overall, low recurrence rates were observed for both TL and TT groups (7 vs. 7%, RR 1.10, 95% CI 0.61–1.96, I2 = 72%), and no statistically significant differences for OS (TL 94.1 vs. TT 94.4%, RR 0.99, CI 0.99–1.00, I2 = 53%), DFS (TL 87 vs. TT 91%, RR 0.96, CI 0.89–1.03, I2 = 85%), and DSS (TL 97.2 vs. TT 95.4%, RR 1.01, CI 1.00–1.01, I2 = 74%). The high degree of heterogeneity of the studies is a notable limitation. Conservative management and appropriate follow-up instead of bilateral surgery would be justifiable in selected patients. These findings highlight the importance of shared-decision making in the management of patients with small, low-risk DTC.
Highlights
Differentiated non-medullary thyroid cancer (DTC) is the most common endocrine malignancy and accounts for 85% of thyroid cancer [1]
While the majority of publications have not found the extent of surgery to impact on the survival of these patients, some report a higher risk for recurrent disease in thyroid lobectomy (TL) [15,16,17,18]
The most recent guideline of the American Thyroid Association (ATA) recommends that TL could be a safe alternative for TT in the treatment of patients with unifocal DTC up to 4 cm in diameter limited to the thyroid, without preoperatively known risk factors such as suspicious lymph nodes on the preoperative ultrasound and without distant metastases at presentation [23]
Summary
Differentiated non-medullary thyroid cancer (DTC) is the most common endocrine malignancy and accounts for 85% of thyroid cancer [1]. The most recent guideline of the American Thyroid Association (ATA) recommends that TL could be a safe alternative for TT in the treatment of patients with unifocal DTC up to 4 cm in diameter limited to the thyroid, without preoperatively known risk factors such as suspicious lymph nodes on the preoperative ultrasound and without distant metastases at presentation [23] The purpose of this meta-analysis is to compare the clinical outcomes in adult patients with low-risk DTC based on two surgical modes, TL versus TT, and discuss in that light the arguments for and against TL and TT in low-risk DTC according to the definition and recommendation of the ATA
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