Surgical Outcomes in Patients With Low-risk Papillary Thyroid Microcarcinoma From MAeSTro Study: Immediate Operation Versus Delayed Operation After Active SurveillanceA Multicenter Prospective Cohort Study

Hyeonuk Hwang; June Young Choi; Hyeong Won Yu; Jae Hoon Moon; Ji-Hoon Kim; Eun Kyung Lee; Yeo Koon Kim; Chang Yoon Lee; Sun Wook Cho; Eun-Jae Chung; Chang Hwan Ryu; Junsun Ryu; Ka Hee Yi; Do Joon Park; Kyu Eun Lee; Young Joo Park; Su-Jin Kim; Yuh-Seog Jung

doi:10.1097/SLA.0000000000005841

Surgical Outcomes in Patients With Low-risk Papillary Thyroid Microcarcinoma From MAeSTro Study: Immediate Operation Versus Delayed Operation After Active SurveillanceA Multicenter Prospective Cohort Study

Ann Surg. 2023 Nov 1;278(5):e1087-e1095. doi: 10.1097/SLA.0000000000005841. Epub 2023 Mar 13.

Authors

Hyeonuk Hwang¹, June Young Choi², Hyeong Won Yu², Jae Hoon Moon³, Ji-Hoon Kim⁴, Eun Kyung Lee⁵, Yeo Koon Kim⁶, Chang Yoon Lee⁷, Sun Wook Cho⁸, Eun-Jae Chung⁹, Chang Hwan Ryu¹⁰, Junsun Ryu¹⁰, Ka Hee Yi¹¹, Do Joon Park⁸, Kyu Eun Lee^{1

12}, Young Joo Park^{8

13}, Su-Jin Kim^{1

12}, Yuh-Seog Jung¹⁰

Affiliations

¹ Department of Surgery, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea.
² Department of Surgery, Seoul National University Bundang Hospital and College of Medicine, Seongnam, Republic of Korea.
³ Department of Internal Medicine, Seoul National University Bundang Hospital and College of Medicine, Seongnam, Republic of Korea.
⁴ Department of Radiology, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea.
⁵ Department of Internal Medicine, National Cancer Center, Goyang, Republic of Korea.
⁶ Department of Radiology, Seoul National University Bundang Hospital and College of Medicine, Seongnam, Republic of Korea.
⁷ Department of Radiology, National Cancer Center, Goyang, Republic of Korea.
⁸ Department of Internal Medicine, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea.
⁹ Department of Otorhinolaryngology, Seoul National University Hospital and College of Medicine, Seoul, Republic of Korea.
¹⁰ Department of Otorhinolaryngology, National Cancer Center, Goyang, Republic of Korea.
¹¹ Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea.
¹² Cancer Research Institute, Seoul National University, Seoul, Republic of Korea.
¹³ Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, Seoul National University, Seoul, Republic of Korea.

PMID: 36912439
DOI: 10.1097/SLA.0000000000005841

Abstract

Objective: To investigate surgical, and clinical outcomes in patients with low-risk papillary thyroid microcarcinoma (PTMC) according to treatment options [immediate operation (IOP) vs delayed operation after active surveillance (AS) (DOP)].

Background: AS has been adopted as an alternative to immediate surgery in patients with low-risk PTMC. Although some patients undergo surgery during AS, there is little information on surgical, and clinical outcomes after delayed operation after AS.

Methods: A multicenter prospective cohort study including 1177 patients was conducted at 3 tertiary hospitals in Korea from June 2016 to January 2020. Patients with low-risk PTMC were enrolled. The participants were self-assigned into AS or IOP, and during AS, the patients underwent surgery if there were signs of disease progression or if the patient's choice changed.

Results: A total of 516 patients underwent operation; 384 (74.4%) in the IOP group and 132 (25.6%) in the DOP group. Compared with the IOP group, the DOP group was significantly associated with a larger tumor size ( P =0.002), higher rates of lymphatic invasion ( P =0.002), and multifocality ( P =0.008). However, the rates of total thyroidectomy, postoperative hypoparathyroidism and vocal cord palsy did not differ significantly between the groups ( P = 0.283, P =0.184, and P =0.284, respectively). Of the 132 patients in the DOP group, disease progression was present in 39 (29.5%) patients. The DOP group with disease progression had a significantly higher rate of lymph node metastasis ( P =0.021) and radioiodine therapy ( P =0.025) than the DOP group without disease progression.

Conclusions: These results suggest that AS might be considered an alternative treatment option for patients with low-risk PTMC regarding the extent of thyroidectomy and postoperative complications in the DOP group. To assess oncologic outcomes, long-term follow-up will be needed.

Trial registration: ClinicalTrials.gov Identifier: NCT02938702.

Publication types

Multicenter Study

MeSH terms

Disease Progression
Humans
Iodine Radioisotopes* / therapeutic use
Prospective Studies
Retrospective Studies
Risk Factors
Thyroid Neoplasms* / pathology
Thyroid Neoplasms* / surgery
Thyroidectomy / methods
Treatment Outcome

Substances

Iodine Radioisotopes

Supplementary concepts

Papillary Thyroid Microcarcinoma

Associated data

ClinicalTrials.gov/NCT02938702