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

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

Endocr Oncol. 2023 Mar 13;3(1):e220095. doi: 10.1530/EO-22-0095. eCollection 2023 Jan 1.

Authors

Benjamin J Worrall^{1

2}, Alexander Papachristos^{1

2}, Ahmad Aniss¹, Anthony Glover^{1

2

3}, Stan B Sidhu^{1

2}, Roderick J Clifton-Bligh^{4

5}, Diana Learoyd⁶, Venessa H M Tsang^{2

4}, Matti Gild^{1

4}, Bruce G Robinson⁴, Mark S Sywak^{1

2}

Affiliations

¹ Endocrine Surgical Unit, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia.
² Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
³ 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.
⁴ Department of Endocrinology and metabolism, Royal North Shore Hospital, Sydney, Australia Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
⁵ Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital, Sydney, Australia.
⁶ GenesisCare North Shore Health Hub Tower A, St Leonards, New South Wales, Australia.

Abstract

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.

Keywords: 2015 American Thyroid Association Guidelines; completion thyroidectomy; differentiated thyroid cancer; papillary thyroid cancer.