C. Schaecher1, A. Yuil-Valdes1, W. Goldner1, A. Fingeret1 1University Of Nebraska College Of Medicine,Omaha, NE, USA
Introduction:
In 2015, the American Thyroid Association updated the Guidelines for Management of Thyroid Nodules and Thyroid Cancer to indicate that thyroid lobectomy is considered an appropriate extent of surgery for well differentiated thyroid carcinoma less than four centimeters without high risk features. We sought to determine whether preoperative features could predict the appropriate extent of surgery in these patients.
Methods:
This is a single institution retrospective review of consecutive adult patients with thyroid nodule biopsy suspicious or malignant and subsequent thyroidectomy from January 2016 through December 2018. Patients with prior thyroidectomy, benign or indeterminate thyroid nodule as indication for thyroidectomy, and patients with concurrent planned parathyroid surgery were excluded. Our primary outcome is rate of completion thyroidectomy for patients undergoing thyroid lobectomy at index operation. Additional outcomes are disease free survival and need for second operation or treatment for recurrence. Data was analyzed using descriptive statistics, univariate analysis on rates of second operation or recurrence. Categorical variables are compared using Fisher's exact and continuous variables using a Mann Whitney U test.
Results:
During the study period, 98 patients had thyroidectomy for suspicious or malignant thyroid nodule biopsy with 25 patients (25.5%) undergoing thyroid lobectomy (TL), 40 patients (40.8%) total thyroidectomy (TT), 23 patients (23.5%) total thyroidectomy with central neck dissection (TT CND), and 10 patients (10.2%) with total thyroidectomy with central and lateral neck dissection (TT CND LND). Of the TL patients, 6 (24%) underwent completion thyroidectomy at a median of 25 days from index operation (IQR 22 – 42 days). Preoperative factors associated with undergoing completion thyroidectomy were male sex and bilateral thyroid nodules. There was no difference in preoperative thyroid stimulating hormone level or nodule size (Table 1). One patient in the completion thyroidectomy group had recurrence and reoperation during follow up, no thyroid lobectomy only patients had recurrence or reoperation. Median follow up did not differ between the groups at 18 months (IQR 7.1 – 28.5months).
Conclusion:
Thyroid lobectomy as index operation can be performed for patients with well-differentiated thyroid carcinoma without high risk features. Male sex and presence of bilateral nodules are associated with undergoing completion thyroidectomy. The overall rate of completion thyroidectomy is 24% in this cohort.
