Short-term QoL Likely Better With Lobectomy vs Thyroidectomy in Lower Risk Differentiated Disease

By Marilynn Larkin

December 28, 2021

NEW YORK (Reuters Health) - In patients with differentiated thyroid cancer (DTC) with low-to-intermediate risk of recurrence, thyroid lobectomy (TL) may yield better short-term health-related quality of life (HRQOL) than total thyroidectomy (TT), researchers suggest.

The prognosis is generally good for patients with DTC, and recently there has been increased controversy regarding optimal management of the condition, according to Dr. Weiming Lv and Dr. Haipeng Xiao, both of Sun Yat-sen University in Guangzhou.

TT and TL are the main surgical approaches for DTC, they write in JAMA Surgery; HRQOL concerns revolve around TT complications - e.g., recurrent laryngeal nerve injury, hypoparathyroidism, hematoma, wound infection - and recurrence risks of TL.

Drs. Lv and Xiao studied data on 563 TL patients and 497 who underwent TT at a single center in China. The median age was 38, and about 78% were women. Because some debates have centered specifically around the extent of surgery needed for patients with DTC tumors measuring 1- to 4-cm, this prespecified subgroup was further analyzed.

Analyses showed that the TT group experienced more postoperative HRQOL problems at 1 and 3 months than those in the TL group, including those with 1- to 4-cm tumors. Specifically, scores on questionnaires addressing neuromuscular symptoms, voice, chills, and tingling were higher with TT in the short term postsurgery. Similarly, TT patients had more anxiety and depression.

However, nearly all between-group differences disappeared at 6 and 12 months postoperatively.

The authors conclude that because HRQOL is not associated with the extent of surgery, "postoperative HRQOL should not be considered when making decisions regarding surgery for patients with DTC. Longer-term HRQOL beyond 1 year requires further observational study with additional follow-up. If better HRQOL is needed in the short term postoperatively, TL may be preferred."

In a related editorial, Dr. Susan Pitt of the University of Michigan in Ann Arbor noted that the controversy over DTC treatment is still not settled. The results of this study are limited, she writes, "by a high rate of nonresponse (15% to 26%), the single-institution design, a low proportion of participants older than 55 years, and the possibility of cultural differences affecting generalizability."

"Determining the optimal treatment for low-risk DTC will require longer-term, prospective, multi-institutional patient reported outcome data including older participants and would ideally be randomized."

Drs. Lv and Xiao did not respond to requests for a comment, nor did Dr. Pitt.

SOURCE: https://bit.ly/3FsR7aN and https://bit.ly/3FBwER2 JAMA Surgery, online December 22, 2021.

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