Is hemithyroidectomy better than total thyroidectomy for papillary thyroid microcarcinoma?

USA: The findings of a new study published in the Journal of the American Medical Association helped characterize existing understanding of the risk-benefit ratio of hemithyroidectomy (HT) vs total thyroidectomy (TT) for the treatment of papillary thyroid microcarcinoma (PTMC) and provide data that may be useful for patient counseling about treatment decisions.

In recent decades, PTMCs have been linked to an increase in thyroid cancer incidence. Historically, total thyroidectomy was the primary treatment, but current recommendations propose hemithyroidectomy for some low-risk tumors; nevertheless, the risk-benefit ratio of the two surgeries is not fully understood. As a result, Vivian Hsiao and colleagues undertook this study to assess surgical complication rates for PTMC therapy between TT and HT.

Medline via the PubMed interface, SCOPUS, and the Cochrane Central Register of Controlled Trials (CENTRAL); no start date limitation; through January 1, 2021. For article retrieval, terms relating to papillary thyroid cancer and its therapy were utilized. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) standard was followed, and the Meta-analysis of Observational Studies in Epidemiology (MOOSE) proposal was followed. Original studies of individuals with main surgical treatment outcomes in PTMC and at least one complication of interest were considered. Articles focusing solely on secondary procedures or non–open surgical methods were not considered. Two independent reviewers selected the studies, extracted the data, and assessed the risk of bias, with a senior reviewer resolving issues.

The key findings of this study were as follows:

1. This systematic review and meta-analysis included 17 studies including 1416 patients undergoing HT and 2411 patients receiving TT.

2. Patients having HT had a considerably decreased risk of acute vocal fold paralysis (3.3% vs 4.5%), temporary hypoparathyroidism (2.2% vs 21.3%), and permanent hypoparathyroidism (2.2% vs 21.3%).

3. Contralateral lobe malignant neoplasm recurrence was 2.3% in the HT group, but not in the TT group.

4. Hemithyroidectomy was linked with a greater overall recurrence rate (3.8% vs. 1.0%), but no difference in recurrence in the thyroid bed or neck was seen.

In conclusion, the results of this study indicate that problems in the surgical therapy of micropapillary thyroid carcinoma increase with the degree of surgery performed, despite the fact that complications and recurrence were minimal for both surgeries.

Reference:

Hsiao, V., Light, T. J., Adil, A. A., Tao, M., Chiu, A. S., Hitchcock, M., Arroyo, N., Fernandes-Taylor, S., & Francis, D. O. (2022). Complication Rates of Total Thyroidectomy vs Hemithyroidectomy for Treatment of Papillary Thyroid Microcarcinoma. In JAMA Otolaryngology–Head & Neck Surgery. American Medical Association (AMA). https://doi.org/10.1001/jamaoto.2022.0621