BACKGROUND
Thyroid cancer is common. Fortunately, thyroid cancer has an excellent prognosis because we have very effective therapy, starting with thyroid surgery. The standard surgery for thyroid cancer used to be removal of the entire thyroid (total thyroidectomy). However, in the last 10 years, we have become better at imaging the thyroid and lymph nodes prior to surgery and have learned more how to identify the less aggressive cancers, so surgeons have been doing less aggressive surgery for thyroid cancer. For smaller and lower-risk cancers, they often just remove part of the thyroid, called a lobectomy. This type of surgery helps patients because they are less likely to need thyroid medicine after surgery and are less likely to have problems like voice changes or low calcium levels. However, when only part of the thyroid is removed, the cancer is a little more likely to come back in the part that was left behind. It’s also harder to find cancer that has spread far away because some special tests don’t work as well.

This study looked at people with a type of thyroid cancer called papillary thyroid carcinoma that had spread a little to nearby lymph nodes on one side of the neck. They determined whether a lobectomy with limited lymph node dissection was safe to perform as compared to a total thyroidectomy.

THE FULL ARTICLE TITLE
Saito Y, et al. Lobectomy vs total thyroidectomy with ipsilateral lateral neck dissection for n1b intermediaterisk papillary thyroid carcinoma. JAMA Otolaryngol Head Neck Surg. Epub 2024 Nov 27; doi: 10.1001/ jamaoto.2024.3860. PMID: 39602155.

SUMMARY OF THE STUDY
Researchers in Japan studied patients with papillary cancer who had surgery between 2005 and 2012. There were 401 patients included (244 had total thyroidectomy, 157 lobectomy), with an average age of 47 years; 21% were male, and the average cancer size was 19 mm. In the lobectomy group, more than one cancer within the thyroid was found in 20% (vs 32% of the total thyroidectomy group) and spread to lymph nodes was noted on 44% (vs. 50%).

WHAT THEY FOUND:

• Survival rates were almost the same whether patients had a total thyroidectomy or just a lobectomy.
• The chance of the cancer coming back was slightly higher for patients who had a lobectomy, but most cancer recurrences happened in the part of the thyroid that was not removed — and these could usually be treated later.
• Overall, the risk of dying from thyroid cancer was very low in both groups.
• Doing a lobectomy also means patients might not need to take thyroid hormone medicine for life and could have fewer side effects like voice changes or problems with calcium levels.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?
Overall, this study gives important information for patients who want to keep part of their thyroid, even if they have some cancer in their lymph nodes. It supports honest conversations between doctors and patients about the pros and cons of each choice. For patients with smaller amounts of cancer spread, it may be safe to do a less aggressive surgery. Patients and doctors can talk together to decide which surgery is best, depending on the patient’s situation and preferences.

— Maria Brito, MD, ECNU

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