Less extensive surgery for low-risk papillary thyroid cancers post 2015 American Thyroid Association guidelines in an Australian tertiary centre |
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| Affiliation: | 1. Department of General Surgery, Monash University Endocrine Surgery Unit, The Alfred Hospital, Melbourne, Australia;2. Department of Surgery, Monash University, Melbourne, Australia;3. Department of Surgery, Monash Health, Melbourne, Australia;1. Department of Surgery, Henry Ford Hospital, 2799 West Grand Blvd, Detroit, MI, 48202, USA;2. Division of Surgical Oncology, Department of Surgery, Henry Ford Hospital, 2800 West Grand Blvd, Detroit, MI, 48202, USA;3. Department of Public Health Sciences, Henry Ford Health System, One Ford Place, Detroit, MI, 48202, USA;1. Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea;2. Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea;3. Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea;4. Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea;1. Division of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy;2. Division of General Surgery, Sandro Pertini Hospital, Rome, Italy;3. Division of HPB, Minimally Invasive and Robotic Surgery, Federico II University, Napoli, Italy;1. Department of General and Oncological Surgery- Surgery C, The Chaim Sheba Medical Center, Tel Hashomer, Israel;2. Sackler School of Medicine, Tel-Aviv University, Israel;3. Gastrointestinal Malignancies Unit at the Institution of Oncology, The Chaim Sheba Medical Center, Tel Hashomer, Israel;4. Gastrointestinal Malignancy Service at Assuta Samson Hospital, Ashdod, Israel;1. Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal;2. Serviço de Cirurgia, Centro Hospitalar Universitário de São João, E.P.E, Alameda Professor Hernâni Monteiro, 4200-319, Porto, Portugal;1. Department of Surgery, Division of Plastic Surgery, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland;2. Departments of Clinical Radiology, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland;3. Departments of Pathology, Diagnostic Imaging Centre, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland;4. University of Eastern Finland, Institute of Clinical Medicine, School of Medicine, Clinical Radiology, Yliopistonranta 1, 70210, Kuopio, Finland;5. University of Eastern Finland, Cancer Center of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland |
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| Abstract: | IntroductionThe 2015 American Thyroid Association guidelines (ATA15) consider hemithyroidectomy (HT) a viable treatment option for low-risk papillary thyroid cancers (PTCs) between 1 and 4 cm. We aimed to examine the impact of ATA15 in a high-volume Australian endocrine surgery unit.MethodsA retrospective study of all patients undergoing thyroidectomy from January 2010 to December 2019. Inclusion criteria: PTC histopathology, Bethesda V-VI, size 1–4 cm, and absence of clinical evidence of lymph node or distant metastases pre-operatively. Primary outcome was rate of HT before and after ATA15.ResultsOf 5408 thyroidectomy patients, 339 (6.3%) met the inclusion criteria – 186 (54.9%) pre-ATA15 (2010–2015) and 153 (45.1%) post-ATA15 (2016–2019). The patient groups were similar; there were no significant differences between groups in age, sex, tumour size, proportion with Bethesda VI cytology, compressive symptoms, or thyrotoxicosis. Post-ATA15, there was a significant increase in HT rate from 5.4% to 19.6% (P = 0.0001). However, there was no corresponding increase in completion thyroidectomy (CT) rate (50.0% versus 27.6%, P = 0.2). The proportion managed with prophylactic central neck dissection (pCND) fell from 80.5% to 10.8% (P < 0.0001). Pre-ATA15, the only factor significantly associated with HT was Bethesda V. In contrast, post-ATA15, HT was more likely in patients with younger age, smaller tumours, and Bethesda V.ConclusionAfter the release of 2015 ATA guidelines, we observed a significant increase in HT rate and a significant decrease in pCND rate for low-risk PTCs in our specialised thyroid cancer unit. This reflects a growing clinician uptake of a more conservative approach as recommended by ATA15. |
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| Keywords: | Papillary thyroid cancer 2015 ATA guidelines Thyroidectomy |
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