Risk of needing completion thyroidectomy for low-risk papillary thyroid cancers treated by lobectomy

Area of Science:

• Endocrinology
• Surgical Oncology
• Pathology

Background:

• American Thyroid Association (ATA) guidelines permit lobectomy for low-risk differentiated thyroid cancers.
• Pathological assessment post-lobectomy is crucial for definitive risk stratification.
• Discordance between initial and final staging often necessitates completion thyroidectomy.

Purpose of the Study:

• To determine the rate of completion thyroidectomy in papillary thyroid cancer (PTC) patients initially treated with lobectomy.
• To identify preoperative factors predicting the need for total thyroidectomy.

Main Methods:

• Retrospective analysis of 275 PTC patients meeting ATA lobectomy criteria (2013-2017).
• Calculation of concordance/discordance rates between initial and final recommendations.
• Multivariable analysis to assess predictors of completion thyroidectomy.

Main Results:

• Discordance requiring completion thyroidectomy occurred in 43.5% of patients.
• Common reasons for discordance included angioinvasion and local invasion.
• No preoperative factors independently predicted the need for total thyroidectomy.

Conclusions:

• Lobectomy alone is insufficient for many PTC patients, with nearly half requiring completion thyroidectomy.
• Total thyroidectomy remains the preferred approach for low-risk 1-4 cm PTC in experienced hands pending improved preoperative risk stratification.