From Lobectomy to Completion Thyroidectomy: A Cohort Study and Systematic Review

Area of Science:

• Endocrinology
• Surgical Oncology
• Thyroid Cancer Management

Background:

• 2015 American Thyroid Association guidelines suggest lobectomy for low-risk thyroid cancer.
• Precise patient selection is vital to avoid unnecessary completion thyroidectomy (CT).
• Evolving guidelines necessitate evaluating contemporary CT rates and indications.

Purpose of the Study:

• To evaluate current rates and reasons for completion thyroidectomy after initial lobectomy.
• To identify patients at higher risk for completion thyroidectomy.
• To improve preoperative decision-making for thyroid cancer management.

Main Methods:

• Retrospective cohort study of patients undergoing CT (2017-2022).
• Systematic literature review following PRISMA guidelines.
• Analysis of demographics, sonography, cytology, pathology, CT indications, and complications.

Main Results:

• Institutional cohort: 37% of patients underwent CT; average interval 3.75 months.
• Systematic review (30 studies, 23,899 patients): pooled CT rate 19.2%.
• Leading indications: aggressive variants (25.4%), lymph node metastasis (23%), ETE (17.5%). Higher CT rates observed for tumors ≥1cm (45%).

Conclusions:

• Completion thyroidectomy is performed in a significant minority post-lobectomy.
• Adverse pathological findings are the primary drivers for CT.
• Enhanced preoperative risk assessment and patient selection are needed as lobectomy becomes more common.