Comparison of Postoperative Unfavorable Events in Patients with Low-Risk Papillary Thyroid Carcinoma: Immediate Surgery Versus Conversion Surgery Following Active Surveillance
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Open Access
- 1 February 2023
- journal article
- research article
- Published by Mary Ann Liebert Inc in Thyroid®
- Vol. 33 (2), 186-191
- https://doi.org/10.1089/thy.2022.0444
Abstract
Background: Active surveillance (AS) for low-risk papillary thyroid microcarcinoma (PTMC) was initiated at Kuma Hospital in 1993 and has gradually spread worldwide. We previously demonstrated that AS is associated with a much lower incidence of unfavorable events than immediate surgery (IS). However, conversion surgery (CS) raises concerns about increased surgical complications due to advanced disease. In this study, we conducted a comparative analysis of unfavorable events following IS and CS. Methods: Between 2005 and 2019, 4635 patients clinically diagnosed with low-risk PTMC at Kuma Hospital were enrolled. Of these, 2896 underwent AS (AS group), and the remaining 1739 underwent IS (IS group). To date, 242 patients (0.8%) in the AS group have undergone CS for various reasons (CS group). Results: The incidence of unfavorable events, such as levothyroxine administration after surgery, postoperative hematoma, transient/persistent hypoparathyroidism, and transient/persistent vocal cord paralysis, did not differ between the CS and IS groups. None of the patients in the CS group had permanent vocal cord paralysis; however, this occurred in 15 patients (0.9%) in the IS group and was caused by accidental injury in 4 patients and carcinoma invasion in 11 patients. The incidence of surgery, levothyroxine administration, postoperative hematoma, transient/permanent hypoparathyroidism, and vocal cord paralysis was significantly higher (p<0.001) in the IS group than in the AS group. There were no differences in the incidence of lymph node recurrence and overall mortality between the AS and IS groups. None of the patients in the AS and IS groups showed distant metastasis or died from thyroid carcinoma. Conclusions: There were no differences in the incidence of unfavorable events between the CS group and the IS group. Although none of the CS and AS groups had permanent vocal cord paralysis, accidental injury of the recurrent laryngeal nerve occurred in four patients (0.2%) in the IS group. The IS group had a significantly higher incidence of unfavorable events than the AS group. The prognoses of patients in both the AS and IS groups were excellent. Therefore, we recommend AS as the first-line management for low-risk PTMC.Keywords
This publication has 21 references indexed in Scilit:
- Active Surveillance for Patients With Papillary Thyroid Microcarcinoma: A Single Center’s Experience in KoreaJournal of Clinical Endocrinology & Metabolism, 2017
- Skin TumoursPublished by Wiley ,2017
- Clinical Trials of Active Surveillance of Papillary Microcarcinoma of the ThyroidWorld Journal of Surgery, 2016
- 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid CancerThyroid®, 2016
- Incidences of Unfavorable Events in the Management of Low-Risk Papillary Microcarcinoma of the Thyroid by Active Surveillance Versus Immediate SurgeryThyroid®, 2016
- Revisiting Low‐Risk Thyroid Papillary Microcarcinomas Resected Without Observation: Was Immediate Surgery Necessary?World Journal of Surgery, 2015
- Patient Age Is Significantly Related to the Progression of Papillary Microcarcinoma of the Thyroid Under ObservationThyroid®, 2014
- Investigation of the prognosis of patients with papillary thyroid carcinoma by tumor sizeEndocrine Journal, 2012
- Therapeutic Strategy for Differentiated Thyroid Carcinoma in Japan Based on a Newly Established Guideline Managed by Japanese Society of Thyroid Surgeons and Japanese Association of Endocrine SurgeonsWorld Journal of Surgery, 2010
- Papillary Microcarcinoma of the Thyroid: How Should It Be Treated?World Journal of Surgery, 2004