Hemithyroidectomyversustotal thyroidectomy for well differentiated T1–2 N0 thyroid cancer: systematic review and meta-analysis

Abstract

Background: Evidence for limiting the extent of surgery in patients with low-risk thyroid cancer is lacking. Methods: A systematic search was performed according to the PRISMA and MOOSE guidelines to assess the effect of total thyroidectomy (TT) with or without radioactive iodine (RAI) treatment versus hemithyroidectomy (HT) on recurrence and overall mortality in patients with differentiated (papillary or follicular) T1-2 N0 thyroid cancer. PubMed, Embase and Cochrane databases were searched, and two authors independently assessed the articles. Results: A total of ten eligible articles were identified. All were observational cohort series, representing a total of 23 134 patients, of which 17 699 were available for meta-analysis. Six studies included patients who had TT followed by RAI treatment. The pooled recurrence rate after TT ± RAI and HT was 2⋅3 and 2⋅8 per cent respectively (odds ratio (OR) 1⋅12, 95 per cent c.i. 0⋅82 to 1⋅53; P = 0⋅48). The pooled 20-year overall survival rate after TT ± RAI was 96⋅8 per cent, compared with 97⋅4 per cent for HT (OR 1⋅30, 0⋅71 to 2⋅37; P = 0⋅40). Overall, higher complication rates were found in the TT ± RAI group. Conclusion: Recurrence rates after HT for treatment of well differentiated T1-2 N0 thyroid cancer were similar to those after TT ± RAI, with a lower incidence of treatment-related complications.

Prophylactic Central Neck Dissection for Clinically Node‐Negative Papillary Thyroid Carcinoma

“…To ensure uniformity in our inclusion criteria, we included all relevant RCTs that performed TT and we excluded Kim et al study 6 since it performed hemithyroidectomy procedures. Notably, among patients with T1‐2 cN0 PTC, a recent meta‐analysis of 10 studies by Rodriguez Schaap et al 32 showed that the recurrence rate did not significantly differ between TT and hemithyroidectomy groups, however, the complication rate was substantially higher in the TT group.…”

Assessment of Radiofrequency Ablation for Papillary Microcarcinoma of the Thyroid

“…However, in case of local tumor growth under active surveillance or in case of patient anxiety about active surveillance, RFA could be a valuable minimally invasive strategy in the management of low-risk mPTC. Different studied treatment options for mPTC and its advantages and disadvantages are described in Table 4 …”

Persistent Postthyroidectomy Hypoparathyroidism in the Netherlands

“…Although promising, the clinical value of ICG angiography in preventing persistent hypoPT is undetermined. Other ways to decrease the incidence of hypoPT could be centralization of thyroid surgery to high-volume centers and hesitancy in performing a TTx . Patients should be informed realistically regarding the complication rate of total or completion thyroidectomy in the context of the gain in the oncological outcome and should be informed about alternative treatments.…”