Lobectomy in patients with differentiated thyroid cancer: indications and follow-up

Abstract

The extent of thyroid surgery for patients with low- and intermediate-risk differentiated thyroid carcinoma (DTC), with a primary tumour <4 cm and no extrathyroidal extension (ETE) or lymph node (LN) metastases, has shifted in a more conservative direction. However, clinicopathological risk factors, including microscopic ETE, aggressive histology, vascular invasion in papillary thyroid carcinoma (PTC) and intermediate volume of LN metastases, can only be identified after completing thyroid lobectomy. It is controversial whether patients with these risk factors should immediately undergo complete thyroidectomy and/or radioactive iodine remnant ablation or should be monitored without further treatments. Data are conflicting about the prognostic impact of these risk factors on clinical DTC outcomes. Notably, the recurrence rate in patients who underwent thyroid lobectomy is low and the few recurrences that develop during long-term follow-up can readily be detected by neck ultrasonography and treated by salvage surgery with no impact on survival. These findings suggest that a more conservative approach may be a preferred management strategy over immediate completion surgery, despite a slightly higher risk of structural recurrence. Regarding follow-up of post-lobectomy DTC patients, it is reasonable that an initial risk stratification system based on clinicohistological findings be used to guide the short-term follow-up prior to evaluating the response to initial therapy and that the dynamic risk stratification system based on the response to initial therapy be used to guide long-term follow-up.

Prevalence and predictor for malignancy of contralateral thyroid nodules in patients with unilateral PTMC: a systematic review and meta-analysis

“…However, the recent consensus statements from the Japan Association of Endocrine Surgery show that no evidence exists that patients with benign nodules should be excluded for active surveillance of PTMC 19 . Furthermore, for low risk PTMC, the few recurrences that develop during long-term follow-up are readily detected and appropriately treated with no impact on survival 20 . Given that PTMC typically exhibits low malignancy, good prognosis 3 , it is widely recognized that "delayed treatment" does not affect the prognosis of patients with low-risk PTMC.…”

Dynamic risk assessment in patients with differentiated thyroid cancer

“…Therefore, the decision for TSH suppression in this group of patients should be made in terms of patient-specific considerations (Lee et al 2019). A review on the indications and follow-up of patients undergoing lobectomy for DTC was recently published (Park & Yoon 2019).…”

The Ongoing Debate Regarding Completion Thyroidectomy Versus Primary Thyroid Surgery for Low and Intermediate Differentiated Thyroid Carcinoma: A Meta-Analysis

“…Our result implies that the surgeon might choose either lobectomy with careful follow-up for recurrence or total thyroidectomy. A careful patient's assessment for risk stratification, a well-informed, preference-based decision, and the surgeon experience might direct the extent of the initial thyroid surgery for DTC [ 22 , 23 ].…”