Lobectomy Doesn’t Raise Reoperation Rates in Thyroid Cancer

TOPLINE:

Although the 2015 American Thyroid Association (ATA) guidelines led to an increase in thyroid lobectomies being performed, it did not result in high rates of early or late reoperation.

METHODOLOGY:

• The 2015 ATA guidelines advocated using either thyroid lobectomy or total thyroidectomy for patients with low-risk differentiated thyroid cancer, which gave rise to concerns that insufficient gland resection may lead to greater disease recurrence and reoperation rates.
• This study examined both early and late reoperations in patients from the Vizient Clinical Data Base who underwent thyroid lobectomy or total thyroidectomy for thyroid cancer before (2013-2015) or after (2016-2021) the change in the ATA guidelines.
• Reoperations were categorized as early or late (≤ 180 days or > 180 days after the initial operation, respectively) and included reoperative thyroid surgery and neck dissection.
• Reoperations performed early were thought to be due to inadequacy of the initial surgical decision, whereas those performed late were believed to be due to potential disease recurrence.

TAKEAWAY:

• Among 65,627 patients, 31.8% underwent initial lobectomy, and 68.2% underwent initial total thyroidectomy.
• The proportion of patients receiving lobectomy as the initial surgery vs total thyroidectomy increased from 19.4% in 2013 to 42.6% in 2021.
• A total of 5884 reoperations (9% of all index operations) were performed during the study period.
• Before and after the change in the ATA guidelines, the overall rate of reoperation in the lobectomy cohort decreased from 37.3% to 17.1%, respectively, whereas the rate in the total thyroidectomy cohort increased from 2.6% to 3.3%, respectively.
• Reoperative thyroid surgery constituted the majority of reoperations after lobectomy.
• After the introduction of the 2015 ATA guidelines, the rate of early reoperations decreased from 34.8% to 14.6% in the lobectomy cohort (P < .001) and increased from 0.7% to 1.0% in the total thyroidectomy cohort (P < .001). Late reoperations remained steady at 2.0%-2.6% in both the cohorts before and after the change in the guidelines.

IN PRACTICE:

“The 2015 ATA guidelines adopted a neutral stance between the choice of thyroid lobectomy and total thyroidectomy for low-risk differentiated thyroid cancers,” the authors wrote. “Since its publication, across the United States, patients with thyroid cancer may be receiving less aggressive guideline-concordant care without incurring an increased risk of reoperation.”

SOURCE:

This study was led by Marin Kheng, MD, MPH, Robert Wood Johnson Medical School, Rutgers Health, New Brunswick, New Jersey, and published online in Thyroid.

LIMITATIONS: 

Tumor staging and histopathologic data to confirm the eligibility for either lobectomy or total thyroidectomy under the 2015 ATA guideline criteria were lacking. The follow-up time for reoperations ranged from 2 to 10 years, with each subsequent year having a shorter follow-up. The database was restricted to reoperations performed within the same center or hospital network, potentially not capturing those performed at outside facilities. 

DISCLOSURES:

This study did not receive any funding. The authors declared no conflicts of interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.