TWO-STEP TOTAL THYROIDECTOMY FOR DIFFERENTIATED THYROID CANCER NOT MEETING LOW-RISK CRITERIA: A POTENTIAL ADVANTAGE FOR PATIENTS

AUTHORS:
R. Kralik (Bratislava, Slovakia) , M. Sabol (Bratislava, Slovakia) , Š. Durdík (Bratislava, Slovakia) , M. Arciniegas (Bratislava, Slovakia) , E. Takácsová (Bratislava, Slovakia) , M. Grigerová (Bratislava, Slovakia)
Background:
Completion thyroidectomy is indicated for patients with differentiated thyroid cancer (DTC) who do not meet the criteria for low-risk tumors. The objective of this study was to assess the risk of surgical complications and oncological outcomes when total thyroidectomy (TTE) is performed in two steps.
Methods:
In a single center from January 1, 2016, to December 31, 2021, TTE for DTC was performed on 375 patients (288 women). Of these, 275 patients underwent primary TTE, and 100 underwent completion TTE. Exclusion criteria included locally advanced cancer and lateral neck compartment node metastases.
Results:
In the completion TTE group, compared to one-step TTE, there was a higher prevalence of aggressive histological variants (33%, OR 5.44, p-value 0), BRAF-negative cancer (71%, OR 2.23, p-value 0.026), and a lower incidence of lymph node metastases in the central neck compartment (32.7%, OR 6.62, p-value 0). Surgical complications revealed no change in the risk of recurrent laryngeal nerve (NLR) damage (1%, OR 0.92, p-value 0.36), but hypoparathyroidism occurred significantly less often (11%, OR 3.25, p-value 0.00011). There was no difference in oncological outcomes assessed by the level of stimulated thyroglobulin three months after surgery (OR 1.71, p-value 0.086).
Conclusions:
Two-step TTE may not be disadvantageous for DTC patients. It does not worsen oncological outcomes and is associated with a lower risk of hypoparathyroidism. The risk of NLR damage remains unchanged.