Pediatric Thyroidectomy: Surgical Extension Does Not Affect Survival

Infographic · Jul 2021 · 1 min read

In brief

National database analysis of 326 matched pediatric patients with early-stage papillary thyroid cancer found no survival difference between total thyroidectomy and lobectomy over median 5-8 year follow-up. Findings challenge current aggressive treatment guidelines and suggest lobectomy may be sufficient for low-risk cases, avoiding lifelong hormone replacement.

Total thyroidectomy does not improve survival vs lobectomy in children with early-stage PTC <4cm (median 5-8yr follow-up, p>0.3)
Current guidelines recommending total thyroidectomy + radioablation for most pediatric PTC may be unnecessarily aggressive for localized disease
Thyroid lobectomy may be adequate for low-risk pediatric PTC, avoiding lifelong thyroid hormone replacement without compromising outcomes
Propensity-matched analysis of 326 pediatric patients showed no difference in overall or disease-specific survival between surgical approaches
Consider less aggressive surgical management for children with localized PTC to reduce treatment burden while maintaining oncologic safety

Written by the GCMD Library team from the infographic.

The infographic uses a red and gray color scheme with anatomical illustrations of the thyroid gland. On the left, patient criteria are listed with a simple icon. The center and right show two thyroid diagrams side-by-side with a 'VS' between them—the left diagram shows dotted outlines (total thyroidectomy) while the right shows solid red fill on one lobe (lobectomy). Large percentage numbers (96% and 100%) are displayed below each surgical approach in bold typography.

Abstract

Background: Current guidelines recommend total thyroidectomy (TT) and radioablation for most papillary thyroid cancer (PTC) in children. These guidelines have been criticized as aggressive, especially for early-stage PTC, as it likely does not influence patient survival and results in life-long thyroid hormone replacement. We sought to study whether the extent of thyroidectomy (TT vs thyroid lobectomy [TL]) influences overall and disease-specific survival in children with localized PTC.

Methods: The National Cancer Database and the Surveillance, Epidemiology, and End Results registries were queried. Patients 18 years or younger with low-risk PTC between 2004 and 2016 were included. Using a 1:1 propensity score matching, patients who underwent TT were matched for age, sex, race, year of diagnosis, and tumor size with a similar cohort of patients who underwent TL. Primary end points were overall survival and disease-specific survival.

Results: There were 3,500 patients identified as surgically treated for PTC, of which 1,325 patients met inclusion criteria for matching. Three hundred and twenty-six patients were matched. One hundred and sixty-three patients had TT; 140 were female and mean age was 16 years (interquartile range [IQR] 13 to 17 years). One hundred and sixty-three patients had TL; 140 were female and mean age was 16 years (IQR 14 to 17 years). Median follow-up was 5.0 years (IQR 2.8 to 8 years) and 8.3 years (IQR 3.6 to 14.4 years) in the National Cancer Database and Surveillance, Epidemiology, and End Results cohorts, respectively. There was no statistically significant difference in overall survival or disease-specific survival in patients with PTC < 4 cm, regardless of whether patients underwent TT or TL (p = 0.32 for National Cancer Database registry and p = 0.67 for Surveillance, Epidemiology, and End Results registry).

Conclusions: This study suggests that the extent of thyroidectomy does not influence survival for pediatric patients with early-stage PTC and that TL might be adequate in this patient population.

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