One- or Two-Step Total Thyroidectomy for Cancer Indications: A 20-Year Retrospective Study from a Referral Center.

Area of Science:

• Endocrinology
• Surgical Oncology
• Thyroid Cancer Research

Background:

• Thyroid cancer (TC) management may involve lobectomy or total thyroidectomy.
• Completion thyroidectomy is sometimes necessary due to unfavorable pathology.
• This study compares morbidity between two-step (TT2) and one-step (TT1) total thyroidectomy for TC.

Purpose of the Study:

• To compare the postoperative morbidity associated with two-step total thyroidectomy (TT2) versus one-step total thyroidectomy (TT1) in thyroid cancer patients.
• To evaluate the safety and complication rates of different surgical timing strategies for total thyroidectomy in TC.

Main Methods:

• Retrospective comparative study at a high-volume endocrine surgery center.
• Included adult patients undergoing TT1 or TT2 for follicular, oncocytic, or papillary TC (2000-2020).
• Propensity score matching (2:1) used to compare surgical complications based on age, sex, BMI, tumor stage, lymph node dissection, and year of surgery.

Main Results:

• 5693 patients analyzed (684 TT2, 5009 TT1).
• TT2 group showed significantly lower transient hypocalcemia rates (3.2% vs. 13.8%, p < 0.001).
• No significant differences observed in permanent hypocalcemia, recurrent laryngeal nerve injury, hematoma, or wound infection rates between TT1 and TT2 groups.

Conclusions:

• Total thyroidectomy in two steps (TT2) is a safe surgical option for thyroid cancer.
• Short- and long-term complication rates for TT2 are comparable to those of TT1.
• TT2 may offer advantages in reducing transient hypocalcemia.