THERMAL ABLATION VERSUS TOETVA FOR A SOLITARY BENIGN THYROID NODULE: CHANGING LANDSCAPE OF PATIENTS PREFERENCES IS COMING TRUE.

AUTHORS:
M. Barczynski (Krakow, Poland) , J. Belowski (Krakow, Poland)
Background:
A changing landscape of patients preferences for treatment of solitary and benign thyroid nodules (SBTN) form conventional surgery to other minimally invasive treatments (MITs) has been witnessed. The aim of this study was to evaluate indications, patients preferences and outcomes of conventional surgery vs laser ablation (LA) vs transoral endoscopic thyroid surgery by vestibular approach (TOETVA) treatments for SBTN.
Methods:
This prospective cohort study included patients with SBTN causing compression symptoms treated at our institution throughout 2020 - 2023. Primary endpoint was patients preferences for treatment. Secondary endpoints were: overall morbidity , need for second line treatment, and satisfaction rate.
Results:
Some 204 patients (F:M = 161:43) with SBTN were offered conventional surgery (thyroid lobectomy) vs TOETVA vs LA. Patients preferences were: 23 (11.3%) for conventional surgery vs 17 (8.3%) for TOETVA vs 164 (80.4%) for LA (p<0.01). Overall morbidity was 2/23 (8.7%) for conventional surgery vs. 2/17 (11.8%) for TOETVA vs 3/164 (1.8%) for LA (p<0.01). Volume reduction rate (VRR) for LA was 63% (range: 32% - 98%) at 6 months following treatment. Spongiform nodules vs fluid-solid tumors vs solid tumors had VRR of 83% vs 67% vs 51%, respectively (p<0.01). Second line treatment was needed for 3/164 (1.8%) patients following LA within a 3-year follow-up. Satisfaction rate was higher for LA and TOETVA vs conventional surgery (p<0.01).
Conclusions:
Currently most patients prefer MITs for SBTN. TOETVA is chosen by minority of patient with a strong motivation to have no scar whereas LA is the preferred MIT nowadays.