Lobectomy and completion thyroidectomy rates increase after the 2015 American Thyroid Association Differentiated Thyroid Cancer Guidelines update

Benjamin J Worrall; Alexander Papachristos; Ahmad Aniss; Anthony Glover; Stan B Sidhu; Roderick J Clifton-Bligh; Diana Learoyd; Venessa H M Tsang; Matti Gild; Bruce G Robinson; Mark S Sywak

doi:10.1530/EO-22-0095

Endocrine Oncology (Apr 2023)

Lobectomy and completion thyroidectomy rates increase after the 2015 American Thyroid Association Differentiated Thyroid Cancer Guidelines update

Benjamin J Worrall,
Alexander Papachristos,
Ahmad Aniss,
Anthony Glover,
Stan B Sidhu,
Roderick J Clifton-Bligh,
Diana Learoyd,
Venessa H M Tsang,
Matti Gild,
Bruce G Robinson,
Mark S Sywak

Affiliations

Benjamin J Worrall: Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia; Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
Alexander Papachristos: Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia; Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
Ahmad Aniss: Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia
Anthony Glover: Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia; Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; The Kinghorn Cancer Centre, Garvan Institute of Medical Research, St. Vincent's Clinical School, Faculty of Medicine, University of New South Wales Sydney, Sydney, New South Wales, Australia
Stan B Sidhu: Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia; Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
Roderick J Clifton-Bligh: Department of Endocrinology and metabolism, Royal North Shore Hospital, Sydney, Australia Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, Australia
Diana Learoyd: GenesisCare North Shore Health Hub Tower A, St Leonards, New South Wales, Australia
Venessa H M Tsang: Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Endocrinology and metabolism, Royal North Shore Hospital, Sydney, Australia Faculty of Medicine and Health, University of Sydney, Sydney, Australia
Matti Gild: Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia; Department of Endocrinology and metabolism, Royal North Shore Hospital, Sydney, Australia Faculty of Medicine and Health, University of Sydney, Sydney, Australia
Bruce G Robinson: Department of Endocrinology and metabolism, Royal North Shore Hospital, Sydney, Australia Faculty of Medicine and Health, University of Sydney, Sydney, Australia
Mark S Sywak: Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia; Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia

DOI: https://doi.org/10.1530/EO-22-0095
Journal volume & issue: Vol. 3, no. 1
pp. 1 – 8

Abstract

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Background: The 2015 American Thyroid Association (ATA) Guidelines permit thyroid lobectomy (TL) or total thyroidectomy in the management of low-risk papillary thyroid cancer (PTC). As definitive risk-stratification is only possible post-operatively, some patients may require completion thyroidectomy (CT) after final histopathological analysis. Methods: A retrospective cohort study of patients undergoing surgery for low-risk PTC in a tertiary referral centre was undertaken. Consecutive adult patients treated from January 2013 to March 2021 were divided into two groups (pre- and post-publication of ATA Guidelines on 01/01/2016). Only those eligible for lobectomy under rule 35(B) of the ATA Guidelines were included: Bethesda V/VI cytology, 1–4 cm post-operative size and without pre-operative evidence of extrathyroidal extension or nodal metastases. We examined rates of TL, CT, local recurrence and surgical complications. Results: There were 1488 primary surgical procedures performed for PTC on consecutive adult patients during the study period, of which 461 were eligible for TL. Mean tumour size (P = 0.20) and mean age (P = 0.78) were similar between time periods. The TL rate increased significantly from 4.5 to 18% in the post-publication period (P < 0.001). The proportion of TL patients requiring CT (43 vs 38%) was similar between groups (P = 1.0). There was no significant change in complications (P = 0.55) or local recurrence rates (P = 0.24). Conclusion: The introduction of the 2015 ATA Guidelines resulted in a modest but significant increase in the rate of lobectomy for eligible PTC patients. In the post-publication period, 38% of patients who underwent TL ultimately required CT after complete pathological analysis.

Published in Endocrine Oncology

ISSN: 2634-4793 (Online)
Publisher: Bioscientifica
Country of publisher: United Kingdom
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the endocrine glands. Clinical endocrinology; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://eo.bioscientifica.com/

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