Conservative treatment of well-differentiated thyroid cancer
Keywords:
Well-differentiated thyroid cancer, conservative treatments, hemithyroidectomy, active surveillance.Abstract
Introduction: The growth of thyroid cancer in recent decades was mainly due to tumors smaller than 1 cm and almost entirely to well-differentiated thyroid cancer. However, mortality did not increase, suggesting that these small tumors have no clinical relevance. This has generated a great debate about the treatment that these tumors should receive. Objective: To identify and analyze the most controversial aspects regarding the surgical treatment of well-differentiated thyroid cancer to contribute to the definition of management strategies.
Material and Methods: A total of 159 articles published between 2016 and 2023 were reviewed by searching for key words in Google and PubMed. Guides developed by representative medical associations from four different regions of the world were also compared.
Results: The most controversial aspect turned out to be the use of more conservative approaches (active surveillance, hemithyroidectomy versus thyroidectomy and dissection or not of the lateral and central compartments of the neck). The success of these strategies is related to clinical, psychological, sociocultural and socioeconomic characteristics of the population, the expertise of surgeons, and access to appropriate diagnostic methods.
Conclusions: The possibility of performing less aggressive procedures for the patient are the most controversial aspects of the surgical treatment of well-differentiated thyroid cancer and the rigorous preparation of the team of imaging specialists and surgeons, the care within a multidisciplinary team, and action protocols that guide a prolonged follow-up are required to achieve their successful implementation.Downloads
References
1. Matrone A, Campopiano MC, Nervo A, Sapuppo G, Tavarelli M, De Leo S. Differentiated thyroid cancer, from active surveillance to advanced therapy:Toward a personalized medicine. Front Endocrinol (Lausanne) [Internet]. 2020;10. Disponible en: http://dx.doi.org/10.3389/fendo.2019.00884
2. Filetti S, Durante C, Hartl D, Leboulleux S, Locati LD, Newbold K, et al. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow- up. Ann Oncol [Internet]. 2019;30(12):1856–83. Disponible en: http://dx.doi.org/10.1093/annonc/mdz400
3. Smulever A, Pitoia F. Conservative management of low-risk papillary thyroid carcinoma: a review of the active surveillance experience. Thyroid Res [Internet]. 2023;16(1). Disponible en: http://dx.doi.org/10.1186/s13044-023-00148-6
4. American Cancer Society. Cancer Facts & Figures. Cancer in Adolescents and Young Adults. Atlanta: G.A.C.S; 2020.
5. Benjamin J, Hephzibah J, Cherian AJ, Mathew D, Shanthly N, Oommen R. Is hemi-thyroidectomy adequate in low risk differentiated thyroid cancer? World J Nucl Med [Internet]. 2019;18(02):171–5. Disponible en: http://dx.doi.org/10.4103/wjnm.wjnm_70_18
6. Murthy SP, Balasubramanian D, Anand A, Limbachiya SV, Subramaniam N, Nair V, et al. Extent of thyroidectomy in differentiated thyroid cancers—review of evidence. Indian J Surg Oncol [Internet]. 2018;9(1):90–6. Disponible en: http://dx.doi.org/10.1007/s13193-017-0661-2
7. Sun Y-D, Zhang H, Zhu H-T, Wu C-X, Chen M-L, Han J-J. A systematic review
and meta-analysis comparing tumor progression and complications between radiofrequency ablation and thyroidectomy for papillary thyroid carcinoma. Front Oncol [Internet]. 2022;12. Disponible en: http://dx.doi.org/10.3389/fonc.2022.994728
8. Scheller B, Culié D, Poissonnet G, Dassonville O, D’Andréa G, Bozec A. Recent
advances in the surgical management of thyroid cancer. Curr Oncol [Internet]. 2023;30(5):4787–804. Disponible en: http://dx.doi.org/10.3390/curroncol30050361
9. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: The American thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid [Internet]. 2016;26(1):1–133. Disponible en: http://dx.doi.org/10.1089/thy.2015.0020
10. Krajewska J, Kukulska A, Samborski K, Czarniecka A, Jarzab B. Lobo- isthmectomy in the management of differentiated thyroid cancer. Thyroid Res [Internet]. 2023;16(1). Disponible en: http://dx.doi.org/10.1186/s13044-022- 00145-1
11. Ito Y, Onoda N, Okamoto T. The revised clinical practice guidelines on the management of thyroid tumors by the Japan Associations of Endocrine Surgeons: Core questions and recommendations for treatments of thyroid cancer. Endocr J [Internet]. 2020;67(7):669– 717. Disponible en: http://dx.doi.org/10.1507/endocrj.ej20-0025
12. Granados-García M, Gallegos-Hernández JF, Gurrola-Machuca H, Flores-Hernández L, Pacheco-Bravo I, Villavicencio-Queijeiro MA, et al. Guía de manejo del nódulo tiroideo y del cáncer diferenciado de tiroides de la Sociedad Mexicana de Oncología. Gac Mex Oncol [Internet]. 2022;17(91). Disponible en: http://dx.doi.org/10.24875/j.gamo.m18000102
13. Mitchell AL, Gandhi A, Scott-Coombes D, Perros P. Management of thyroid cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016;130(S2):S150–60.
14. Pacini F, Basolo F, Bellantone R, Boni G, Cannizzaro MA, De Palma M, et al. Italian consensus on diagnosis and treatment of differentiated thyroid cancer: joint statements of six Italian societies. J Endocrinol Invest [Internet]. 2018;41(7):849–76. Disponible en: http://dx.doi.org/10.1007/s40618-018-0884-2
15. Wang F, Yu X, Shen X, Zhu G, Huang Y, Liu R, et al. The prognostic value of tumor multifocality in clinical outcomes of papillary thyroid cancer. J Clin Endocrinol Metab [Internet]. 2017;102(9):3241–50. Disponible en: http://dx.doi.org/10.1210/jc.2017-00277
16. Diker-Cohen T, Hirsch D, Shimon I, Bachar G, Akirov A, Duskin-Bitan H, et al. Impact of minimal extrathyroid extension in differentiated thyroid cancer: Systematic review and Meta-analysis. J Clin Endocrinol Metab [Internet]. 2018;103(6):2100–6. Disponible en: http://dx.doi.org/10.1210/jc.2018-00081
17. Molinaro E, Campopiano MC, Pieruzzi L, Matrone A, Agate L, Bottici V, et al. Active surveillance in papillary thyroid microcarcinomas is feasible and safe: Experience at a single Italian center. J Clin Endocrinol Metab [Internet]. 2020;105(3):e172–80. Disponible en: http://dx.doi.org/10.1210/clinem/dgz113
18. Kuczma P, Demarchi MS, Leboulleux S, Trésallet C, Mavromati M. Djafarrian Central node dissection in papillary thyroid carcinoma in the era of nea fluorescence. Front Endocrinol (Lausanne) [Internet]. 2023;14:1110489. Disponible en: http://dx.doi.org/10.3389/fendo.2023.1110489
19. Metere A, Aceti V, Giacomelli L. The surgical management of locally advanced well-differentiated thyroid carcinoma: changes over the years according to the AJCC 8th edition Cancer Staging Manual. Thyroid Res [Internet]. 2019;12(1). Disponible en: http://dx.doi.org/10.1186/s13044-019-0071-3
20. Ritter A, Bachar G, Hirsch D, Benbassat C, Katz O, Kochen N, et al. Natural history of contralateral nodules after lobectomy in patients with papillary thyroid carcinoma. J Clin Endocrinol Metab [Internet]. 2018;103(2):407–14. Disponible en: http://dx.doi.org/10.1210/jc.2017-01616
21. Tuttle RM, Zhang L, Shaha A. A clinical framework to facilitate selection of patients with differentiated thyroid cancer for active surveillance or less aggressive initial surgical management. Expert Rev Endocrinol Metab [Internet]. 2018;13(2):77–85. Disponible en: http://dx.doi.org/10.1080/17446651.2018.1449641
22. Kuba S, Yamanouchi K, Hayashida N, Maeda S, Adachi T, Sakimura C, et al. Total thyroidectomy versus thyroid lobectomy for papillary thyroid cancer: Comparative analysis after propensity score matching: A multicenter study. Int J Surg [Internet]. 2017;38:143–8. Disponible en: http://dx.doi.org/10.1016/j.ijsu.2016.09.083
23. Fackelmayer OJ, Inabnet WB III. Lobectomy or total thyroidectomy—where is
the pendulum now for differentiated thyroid cancer?. Surg Oncol Clin N Am [Internet]. 2023;32(2):373–81. Disponible en: http://dx.doi.org/10.1016/j.soc.2022.10.011
24. Rodriguez A, Hans S, Lechien JR. Post‐thyroidectomy voice and swallowing disorders and association with laryngopharyngeal reflux: A scoping review. Laryngoscope Investig Otolaryngol [Internet]. 2023;8(1):140–9. Disponible en: http://dx.doi.org/10.1002/lio2.1009
25. Deguelte S, Colas PA, Guerin C, Leboulleux S, Najah H, Lifante JC. Extent of thyroidectomy: When should hemithyroidectomy be performed? Recommendations from the Francophone Association for Endocrine Surgery, the French Society of Endocrinology and the French Society of Nuclear Medicine. J Visc Surg [Internet]. 2023;160(3):S69–78. Disponible en: http://dx.doi.org/10.1016/j.jviscsurg.2023.04.011
26. McLeod DSA, Zhang L, Durante C, Cooper DS. Contemporary debates in adult papillary thyroid cancer management. Endocr Rev [Internet]. 2019;40(6):1481–99. Disponible en: http://dx.doi.org/10.1210/er.2019-00085
27. Ortega Peñate JA, Díaz Alonso O, Cora Abraham J, Méndez Fleitas L, Ortega Rodríguez Y. Resultado del tratamiento quirúrgico del cáncer de tiroides Hospital Universitario Comandante “Faustino Pérez Hernández” Matanzas. Rev médica electrón [Internet]. 2020 [Citado 13/08/2023];42(6):2621–32. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1684- 18242020000602621
28. Acosta Guerrero G, Delgado Llorca F, Ricardo Martínez D, Guerra Corría Y. Caracterización clínica y epidemiológica de pacientes operados por câncer de tiroides. Multimed [Internet]. 2022. [Citado 13/11/2023];26(1). Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1028- 48182022000100008
29. Lorda Galiano L, Navas Igarza JO, Hidalgo Herrera M, Rodríguez Fernández Y. Tratamiento quirúrgico ambulatorio en la solución de las afecciones de la glándula tiroides. Rev Cuba Med Mil [Internet]. 2022 [Citado 13/11/2023 ];51(2). Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0138- 65572022000200019
30. Ramírez Núñez E, Moró Vela RÁ, Llime Matos Y, Reyes Domínguez Y. Manejo quirúrgico de tumores tiroideos en el Hospital General Docente “Dr. Agostinho Neto”, Guantánamo 2016-2018. Revista Información Científica [Internet]. 2019 [Citado 13/11/2023];98(3):355–63. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_abstract&pid=S1028- 99332019000300355
31. Sánchez Padrón EL. Giro Rojas D. Díaz Figueredo EA. Manejo quirúrgico de las afecciones malignas de la glándula tiroidea en Las Tunas 2014- 2018. En: XXXI Fórum Nacional de las Ciencias Médicas [Internet]. La Habana; UCMH;2018. Disponible en: http://www.forumestudiantilcienciasmedicas.sld.cu/index.php/forum/2020/paper/viewFile/12/12
32. Ortíz JAS, Díaz JGL, Collado NBS, Pascual YR, Pérez RB, Bermúdez EJC. Caracterización de pacientes operados de la tiroides en los dos hospitales provinciales de Holguín. Correo Científico Médico [Internet]. 2021 [Citado 13/11/2023];25(4). Disponible en: https://revcocmed.sld.cu/index.php/cocmed/article/view/4048/2004
33. Suárez Cuevas A, Albertini López G, Garrido García JR, Abraham Cardoso J. Caracterización de enfermos con cáncer de tiroides operados en el Hospital Clínico Quirúrgico General “Freyre de Andrade.” Rev Cuba Cir [Internet]. 2022 [Citado 13/11/2023];61(3). Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034- 74932022000300004
34. Robert ZO, Querts VJA, Chuy AS. Experiencia en cirugía de tiroides en el Hospital Oncológico “Conrado Benítez de Santiago de Cuba. Rev Cuba Cir [Internet]. 2023. [Citado 13/11/2023];62(2). Disponible en: https://revcirugia.sld.cu/index.php/cir/article/view/1500/807
35. Sardiñas Ponce R, Guerra Leal OA. Experiencia de ocho años en tiroidectomías en el Hospital General Docente “Dr. Enrique Cabrera Cossío.” Rev Cuba Cir. 2021;60(4).
36. Jiménez García Y, Martínez Bravo Y, Martínez Díaz O, López Caraballo D, Linares Cánovas L, Gómez Blanco D. Caracterización de pacientes con patologías tiroideas intervenidos quirúrgicamente. Finlay [Internet]. 2018. [Citado 13/11/2023];8(4):258–66. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S2221- 24342018000400003
37. Puerto Lorenzo JA, Torres Ajá L, Pérez Quintana E. Caracterización de los pacientes operados de afecciones nodulares de tiroides. Rev Cuba Cir [Internet]. 2022. [Citado 13/11/2023];61(3). Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034- 74932022000300002
38. Sosa G, Ernand S. Complicaciones derivadas de la tiroidectomía en el Hospital Universitario"General Calixto García". Rev Cubana Cirugía [Internet]. 2016 [Citado 13/11/2023];55(4). Disponible en: http://www.revcirugia.sld.cu/(http://www.revcirugia.sld.cu/
39. González R, Llapur A, Pérez D. Cirugía conservadora y tiroidectomía total en el cáncer tiroideo bien diferenciado. Rev Cubana Cirugía [Internet]. 2017 [Citado 13/11/2023];56(4). Disponible en: http://www.revcirugia.sld.cu/(http://www.revcirugia.sld.cu/
40. Mesa Izquierdo O, Valdés Serrat LM, Barrios Cruz D, Matos Ramos YA, Travieso Peña G. Comportamiento quirúrgico de las patologías del tiroides. Rev Cubana Cir [Internet]. 2020 [Citado 13/11/2023];59(1). Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034- 74932020000100006
41. Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. Cancer J Clin [Internet]. 2022;72(1):7–33. Disponible en: http://dx.doi.org/10.3322/caac.21708
42. Gordon AJ, Dublin JC, Patel E, Papazian M, Chow MS, Persky MJ, et al. American Thyroid Association guidelines and national trends in management of papillary thyroid carcinoma. JAMA Otolaryngol Head Neck Surg [Internet]. 2022;148(12):1156. Disponible en: http://dx.doi.org/10.1001/jamaoto.2022.3360
43. Benjamin J. Is hemi‐thyroidectomy adequate in low risk differentiated thyroid
cancer. World J Nucl Med [Internet]. 2019;18(2):171–5. Disponible en: http://doi.org/10.4103/wjnm.WJNM_70_18
44. Vera Muthre E, Lazo Caicedo C, Cedeño Loor S, Bravo Bermeo C. Actualización sobre el cáncer de tiroides. RECIMUNDO [Internet]. 2018;2(3):16–42. Disponible en: http://dx.doi.org/10.26820/recimundo/2.(3).julio.2018.16-42
45. Rossi L, Materazzi G, Bakkar S, Miccoli P. Recent trends in surgical approach to thyroid cancer. Front Endocrinol (Lausanne) [Internet]. 2021;12. Disponible en: http://dx.doi.org/10.3389/fendo.2021.699805
46. Xu J, Ding K, Mu L, Huang J, Ye F, Peng Y, et al. Hashimoto’s thyroiditis: A“double-edged sword” in thyroid carcinoma. Front Endocrinol (Lausanne) [Internet]. 2022;13. Disponible en: http://dx.doi.org/10.3389/fendo.2022.801925
47. Shill DK, Roobol MJ, Ehdaie B, Vickers AJ, Carlsson SV. Active surveillance for prostate cancer. Transl Androl Urol [Internet]. 2021;10(6):2809–19. Disponible en: http://dx.doi.org/10.21037/tau-20-1370
48. Kim TY, Shong YK. Active surveillance of papillary thyroid microcarcinoma: A mini-review from Korea. Endocrinol Metab (Seoul) [Internet]. 2017;32(4):399. Disponible en: http://dx.doi.org/10.3803/enm.2017.32.4.399
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