Total Thyroidectomy Versus Lobectomy for Thyroid Cancer: Single-Center Data and Literature Review

Carla Colombo,Marta Di Stefano,Matteo Trevisan,Claudia Moneta,Leonardo Vicentini,Laura Fugazzola,Simone De Leo

doi:10.1245/s10434-020-09481-8

Abstract

BackgroundControversies remain about the ideal risk-based surgical approach for differentiated thyroid cancer (DTC).MethodsAt a single tertiary care institution, 370 consecutive patients with low- or intermediate-risk DTC were submitted to either lobectomy (LT) or total thyroidectomy (TT) and were followed up.ResultsEvent-free survival by Kaplan–Meier curves was significantly higher after TT than after LT for the patients with either low-risk (P = 0.004) or intermediate-risk (P = 0.032) tumors. At the last follow-up visit, the prevalence of event-free patients was higher in the TT group than in the LT low-risk group (95% and 87.5%, respectively; P = 0.067) or intermediate-risk group (89% and 50%; P = 0.008). No differences in persistence prevalence were found among microcarcinomas treated by LT or TT (low risk, P = 0.938 vs. intermediate-risk, P = 0.553). Nevertheless, 15% of the low-risk and 50% of the intermediate-risk microcarcinomas treated by LT were submitted to additional treatments. On the other hand, macrocarcinomas were significantly more persistent if treated with LT than with TT (low-risk, P = 0.036 vs. intermediate-risk, P = 0.004). Permanent hypoparathyroidism was more frequent after TT (P = 0.01). After LT, thyroglobulin (Tg)/thyroid-stimulating hormone (TSH) had shown decreasing trend in 68% of the event-free patients and an increasing trend in the persistent cases.ConclusionsLobectomy can be proposed for low-risk microcarcinomas, although in a minority of cases, additional treatments are needed, and a longer follow-up period usually is required to confirm an event-free outcome compared with that for patients treated with TT. On the other hand, to achieve an excellent response, TT should be favored for intermediate-risk micro- and macro-DTCs despite the higher frequency of postsurgical complications.

Highlights

Controversies remain about the ideal riskbased surgical approach for differentiated thyroid cancer (DTC)
We report data from an Italian series of differentiated thyroid cancers (DTCs) divided into American Thyroid Association (ATA) low- and intermediate-risk classes and treated with LT or TT
After a mean follow up period of 7 years, the patients treated with LT were found to require more additional therapies after initial surgery, to harbor a worse disease response at the dynamic risk stratification, and to have a lower event-free survival according to Kaplan-Meyer curves than the patients treated with TT

Summary

Introduction

Controversies remain about the ideal riskbased surgical approach for differentiated thyroid cancer (DTC). At a single tertiary care institution, 370 consecutive patients with low- or intermediate-risk DTC were submitted to either lobectomy (LT) or total thyroidectomy (TT) and were followed up. Event-free survival by Kaplan–Meier curves was significantly higher after TT than after LT for the patients with either low-risk (P = 0.004) or intermediate-risk (P = 0.032) tumors. At the last follow-up visit, the prevalence of event-free patients was higher in the TT group than in the LT low-risk group (95% and 87.5%, respectively; P = 0.067) or intermediate-risk group (89% and 50%; P = 0.008). No differences in persistence prevalence were found among microcarcinomas treated by LT or TT (low risk, P = 0.938 vs intermediate-risk, P = 0.553). 15% of the low-risk and 50% of the intermediate-risk microcarcinomas treated by LT were submitted to additional treatments.

Methods

Results

Conclusion