Estimating the risk of completion total thyroidectomy using real-world data to guide initial surgical decision-making for patients with clinical low-risk papillary thyroid carcinoma

查看全文 作　　者：Wen [1]Liu;Xiangxiang [1]Zhan;Zhizhong [1]Dong;Yanjun [1]Su;Jianming [1]Zhang;Jun [1]Qian;Yunhai [1]Ma;Chang [1]Diao;Ruochuan [1]Cheng 机构地区：[1]Department of Thyroid Surgery,Clinical Research Center for Thyroid Diseases of Yunnan Province,the First Affiliated Hospital of Kunming Medical University,Yunnan,Kunming,China 出　　处：《Holistic Integrative Oncology》索引2022年第1卷第1期,共9页 基　　金：supported by grants from the“Ten Thousand People Plan”of Yunnan Province-Medical Experts Project[RLCRC20210412]. 摘　　要：Background:Continuing controversy exists in diferent guidelines’recommendations regarding whether total thyroidectomy(TT)or lobectomy is the optimal surgery for patients with low-risk papillary thyroid carcinoma(PTC).Diverse perceptions of the risk of completion TT after lobectomy are the main debate between guidelines and institutions.Methods:Patients who underwent thyroidectomy and prophylactic central lymph node dissection for≤4 cm PTC(January 2007 to December 2020)by high-volume surgeons were included.Patients with preoperatively known highrisk characteristics or suspicious bilateral multifocality were excluded.The pathological fndings were defned as the risk stratifcations of completion TT from low to high to evaluate which initial surgical procedure could allow more patients to meet the criteria of optimal surgical extent.Results:Of 4965 consecutive patients met lobectomy criteria as the initial operation.Aggressive histological subtypes were found in 2.5%of patients,T3b disease in 1.1%,T4 disease in 3.1%,LNs involved≤5 in 29.5%,LNs involved>5 in 3.1%,and incidental bilateral multifocality in 7.9%.According to our defned risk stratifcation system,TT and lobectomy would be considered the optimal initial procedure in 12.0%and 67.2%PTC patients with a tumor≤1 cm and 28.7%and 36.6%in the 1-4 cm groups in our real-world cohort,respectively.Conclusion:Lobectomy alone,as an initial procedure,could allow more low-risk PTC patients with a tumor either≤1 cm or 1-4 cm to achieve the optimal surgical extent.Moreover,surgeons should balance the high-risk characteristics and complication risks during surgery to re-evaluate surgical decision-making. 关 键 词：Papillary thyroid cancer Completion thyroidectomy Risk stratifcation Extent of thyroidectomy ATA guidelines