Abstract

Purpose: Recently, the management of patients with low-risk differentiated non-medullary thyroid cancer (DTC), has been critically appraised, questioning whether these patients might be overtreated without a clear clinical benefit. The American Thyroid Association (ATA) guideline suggests that thyroid lobectomy (TL) could be a safe alternative for total thyroidectomy (TT) in the treatment of patients with DTC up to 4cm in diameter limited to the thyroid, without locoregional or distant metastases. This meta-analysis aims to evaluate the impact of surgical extent on recurrence and mortality outcomes for these patients.

Methods: A review of the literature was performed using MEDLINE (Pubmed) database. We conducted a meta-analysis to assess the clinical outcomes in patients with low-risk DTC based on the extent of surgery. The relative risks (RR) of recurrence rate, overall survival (OS), disease-free survival (DFS) and disease specific survival (DSS) were estimated.

Results: In total 16 studies with 175,430 patients met the inclusion criteria for this meta-analysis. Overall, low recurrence rates were observed for both TL and TT groups (9.0 vs. 6.7%, RR 1.10, 95% CI 0.61-1.96, I² = 77%). Also no statistical significant difference for recurrence, OS (TL 94.1 vs. TT 94.4%, RR 0.99, CI 0.99-1.00, I² = 53%), DFS (TL 86.5 vs. TT 90.2%, RR 0.96, CI 0.89-1.03, I² = 85%), and DSS (TL 97.2 vs. TT 95.4%, RR 1.01, CI 1.00-1.01, I² = 74%).

Conclusion: This meta-analysis indicates that low-risk DTC patients who underwent TL vs. TT did not differ on recurrence, OS, DFS and DSS. Given the large proportion of patients who could benefit from a stepwise approach, conservative management and appropriate follow-up instead of bilateral surgery would be justifiable in selected patients. These findings highlight the importance of shared-decision making in the management of patients with small, low-risk DTC.