Half of lobectomies for papillary thyroid cancer end in total or completion thyroidectomy
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Total or completion thyroidectomy during or after a lobectomy may be necessary for half of adults with low-risk papillary thyroid cancer who are candidates for lobectomy, according to findings published in Thyroid.
“A high proportion of patients that would seemingly be eligible for conservative thyroid lobectomy will ultimately require intra-operative conversion to a total thyroidectomy or require a completion thyroidectomy as a second step,” Shamir P. Chandarana, MD, MSc, FRCSC, clinical associate professor in the section of otolaryngology-head and neck surgery in the department of surgery in the faculty of medicine at Cumming Medical School at the University of Calgary in Canada, told Endocrine Today. “Surgeons must maintain a high level of diligence in making appropriate treatment choices with regard to extent of surgery for well-differentiated thyroid cancer.”
Chandarana and colleagues used data from the lobectomy procedures between 2008 and 2017 in Alberta, Canada, of 709 adults with papillary thyroid cancer (mean age, 46.5 years; 81% women). The surgeons who performed the procedures used the 2015 American Thyroid Association guidelines to determine whether patients should have the surgery, according to the researchers, who identified when surgeons needed to switch to total thyroidectomy during lobectomy due to “invasion into local structures” or metastatic lymph nodes. The researchers also determined whether a completion thyroidectomy was eventually needed based on evidence of high-risk pathologic features in histopathology data.
The researchers found that a change to a total thyroidectomy was necessary in 21% of procedures and that high-risk pathologic features were found and led to completion thyroidectomy for an additional 30% of participants. The researchers further noted that these results were not altered if they changed the age or the tumor size needed to necessitate lobectomy.
“[This study] highlights the need for a better preoperative decision-making tool, when trying to decide on extent of thyroid surgery for well-differentiated thyroid cancer,” Chandarana said. “Patients must be counselled that despite an initial plan to perform thyroid lobectomy, just over half will ultimately end up having undergone a total thyroidectomy either in one or two steps.” – by Phil Neuffer
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Shamir P. Chandarana, MD, MSc, FRCSC, can be reached at shamir.chandarana@ucalgary.ca.
Disclosures: The authors report no relevant financial disclosures.
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