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Hemithyroidectomy versus total thyroidectomy in the intermediate-risk differentiated thyroid cancer: the Italian Societies of Endocrine Surgeons and Surgical Oncology Multicentric Study

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Abstract

The surgical treatment of the intermediate-risk DTC (1–4 cm) remains still controversial. We analyzed the current practice in Italy regarding the surgical management of intermediate-risk unilateral DTC to evaluate risk factors for recurrence and to identify a group of patients to whom propose a total thyroidectomy (TT) vs. hemithyroidectomy (HT). Among 1896 patients operated for thyroid cancer between January 2017 and December 2019, we evaluated 564 (29.7%) patients with unilateral intermediate-risk DTC (1–4 cm) without contralateral nodular lesions on the preoperative exams, chronic autoimmune thyroiditis, familiarity or radiance exposure. Data were collected retrospectively from the clinical register from 16 referral centers. The patients were followed for at least 14 months (median time 29.21 months). In our cohort 499 patients (88.4%) underwent total thyroidectomy whereas 65 patients (11.6%) underwent hemithyroidectomy. 151 (26.8%) patients had a multifocal DTC of whom 57 (10.1%) were bilateral. 21/66 (32.3%) patients were reoperated within 2 months from the first intervention (completion thyroidectomy). Three patients (3/564) developed regional lymph node recurrence 2 years after surgery and required a lymph nodal neck dissection. The single factor related to the risk of reoperation was the histological diameter (HR = 1.05 (1.00–1-09), p = 0.026). Risk stratification is the key to differentiating treatment options and achieving better outcomes. According to the present study, tumor diameter is a strong predictive risk factor to proper choose initial surgical management for intermediate‐risk DTC.

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Abbreviations

DTC:

Differentiated thyroid cancer

TT:

Total thyroidectomy

HT:

Hemityroidectomy

ATA:

American Thyroid Association

US:

Ultrasonography

FNA:

Fine-needle aspiration

CND:

Central neck dissection

LND:

Lateral neck dissection

Tg:

Thyroglobulin

RAI:

Radioactive iodine

SIUEC:

Unitary Italian Society of Endocrinology

SICO:

Italian Society of Oncological Surgery

pts:

Patients

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Funding

The promoter and coordinator Center did not receive funding or external collaborations in the study drafting. Furthermore, it is confirmed that the study does not provide external funding.

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Authors and Affiliations

Authors

Contributions

DC, SN, GF and NdM: participated substantially in the conception, design, and execution of the study and in the analysis and interpretation of data; also participated substantially in the drafting and editing of the manuscript. RM, DCC, SL, DG, AGL, MM,VE, DG, SS, BM, PI, DPL, TM, GA, PA, PA, LS, CPG, GG, MA, DL, PD, RR, IM, IN, LCP: participated substantially in conception, design, and execution of the study; also participated substantially in the editing of the manuscript.

Corresponding author

Correspondence to N. Samardzic.

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Conflict of interest

Dobrinja C., Samardzic N., Giudici F., Raffaelli M., De Crea C., Sessa L, Docimo G, 4. Ansaldo G.L., Minuto M., Varaldo E., Dionigi G, Spiezia S, Boniardi M., Pauna I, De Pasquale L., Testini M, Gurrado A, Pasculli A, Pezzolla A, Lattarulo S, Calò P.G., Graceffa G., Massara A., Docimo L., Parmeggiani D., Ruggiero R, Iacobone M., Innaro N, Lombardi C.P., de Manzini N. declare that they have no conflict of interest related to this article. This study has been proposed by the Unitary Italian Society of Endocrinology (SIUEC) and to the Italian Society of Oncological Surgery (SICO), which accept it in all its parts and promote it to the associated structures. All authors declare that they have no conflict of interest.

Ethical approval

This research involved only human participants and was in accordance with the 1964 Helsinki Declaration. This study was approved by the institutional Ethics Committee of the Cattinara Hospital ASUGI, (study ID 3264—001_2020H).

Research involving human participants and/or animals

This article does not contain any studies on animals performed by any of the authors.

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Informed consent was obtained from all patients.

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Dobrinja, C., Samardzic, N., Giudici, F. et al. Hemithyroidectomy versus total thyroidectomy in the intermediate-risk differentiated thyroid cancer: the Italian Societies of Endocrine Surgeons and Surgical Oncology Multicentric Study. Updates Surg 73, 1909–1921 (2021). https://doi.org/10.1007/s13304-021-01140-1

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