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Immediate surgery for low-risk thyroid cancer raises likelihood of unfavorable events
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Researchers found similar oncologic outcomes for low-risk papillary microcarcinoma managed with immediate surgery and active surveillance; however, immediate surgery was associated with more unfavorable events, according to recent study findings published in Thyroid.
“Even [papillary microcarcinomas] 1 cm or smaller in maximum diameter may be associated with lymph node metastases, distant metastases (although very rare), or invasion to the recurrent laryngeal nerve causing [vocal cord paralysis],” the researchers wrote. “These symptomatic [papillary microcarcinomas] have aggressive characteristics and should be treated appropriately. However, the vast majority of the [papillary microcarcinomas] incidentally detected during imaging studies do not show these aggressive features.”
Aki r a Miyauchi , MD, PhD, of the department of surgery at Kuma Hospital in Kobe, Japan, and colleagues evaluated 2,153 patients diagnosed with low-risk papillary microcarcinoma by ultrasound-guided fine-needle aspiration (FNA) biopsy from February 2005 to August 2013 at Kuma Hospital. Participants chose active surveillance (n = 1,179) or immediate surgery (n = 974). The researchers sought to determine the unfavorable events after the two approaches.
Eight percent of participants who underwent active surveillance subsequently underwent surgery, most commonly because the participant changed his or her mind (54%), followed by increase in tumor size by 3 mm or more (2.3%) and novel lymph node metastases (0.5%). Five of the participants who underwent surgery experienced a recurrence. No participant developed distant metastases or died of thyroid cancer.
The rate of temporary vocal cord paralysis was higher in the immediate-surgery group (4.1%) compared with the active-surveillance group (0.6%; P < .0001). Participants in the active-surveillance group who experienced temporary vocal cord paralysis underwent conversion therapy, and one experienced temporary idiopathic vocal cord paralysis contralateral to the papillary microcarcinoma. Two participants in the immediate-surgery group experienced permanent vocal cord paralysis. All cases of vocal cord paralysis were related to thyroid surgery with the exception of the case of temporary idiopathic vocal cord paralysis.
Temporary hypoparathyroidism was more common in the immediate-surgery group (16.7%) compared with the active-surveillance group (2.8%; P < .0001). All participants in the active-surveillance group who experienced temporary hypoparathyroidism underwent conversion surgery. Compared with the active-surveillance group (0.08%), the immediate-surgery group had a higher incidence of permanent hypoparathyroidism (1.6%; P < .0001).
More participants in the immediate-surgery group (66.1%) were on levothyroxine compared with the active-surveillance group (20.7%; P < .0001).
“In conclusion, the oncological outcomes of the immediate surgery and active surveillance were similarly excellent,” the researchers wrote. “The incidences of unfavorable events were definitely higher in the immediate-surgery group than in the active-surveillance group, and we now recommend active surveillance as the best choice for patients with low-risk [papillary microcarcinomas].” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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