Long-term comparison of Image-guided thermal ablation vs. lobectomy for solitary papillary thyroid microcarcinoma: a multicenter retrospective cohort study

Lin Yan; WenHui Li; YaLin Zhu; Xinyang Li; Yingying Li; Yiming Li; Qing Song; Ying Che; Hui Wang; Yukun Luo

doi:10.1097/JS9.0000000000001595

Long-term comparison of Image-guided thermal ablation vs. lobectomy for solitary papillary thyroid microcarcinoma: a multicenter retrospective cohort study

Int J Surg. 2024 May 15. doi: 10.1097/JS9.0000000000001595. Online ahead of print.

Authors

Lin Yan¹, WenHui Li², YaLin Zhu³, Xinyang Li¹, Yingying Li¹, Yiming Li¹, Qing Song⁴, Ying Che³, Hui Wang², Yukun Luo¹

Affiliations

¹ Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Beijing, China.
² Depart of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China.
³ Department of Ultrasound, First Affiliated Hospital of Dalian Medical University, Dalian, China.
⁴ Department of Ultrasound, Seventh Medical Center, Chinese PLA General Hospital, Beijing, China.

PMID: 38752497
DOI: 10.1097/JS9.0000000000001595

Abstract

Background: Image-guided thermal ablation has been applied in patients with papillary thyroid microcarcinoma(PTMC) who refuse surgery or active surveillance. However, evidence to support ablation is limited by single-center designs and lack of long-term data. The purpose of this study was to compare long-term outcomes between ablation and lobectomy for patients with solitary PTMC.

Materials and methods: This multicenter retrospective study included 1021 consecutive patients with solitary PTMC who underwent ablation(n=444) or lobectomy(n=577) at the four university-affiliated hospitals. The primary outcomes were disease progression(lymph node metastasis[LNM], recurrent tumors, persistent tumors and distant metastasis) and disease-free survival(DFS). Secondary outcomes were complications, hospitalization, procedure time, estimated blood loss and cost. The two groups were compared using propensity score matching.

Results: After matching, no significant differences were observed in disease progression (4.7% vs. 3.4%, P=.307), LNM (1.6% vs. 1.6%, P=1.000), recurrent tumors (2.9% vs. 1.8%, P=.269), persistent tumors(0.2% vs. 0%, P=.317) and DFS (95.5% vs. 97.1%, P=.246) between the ablation and lobectomy groups during the median follow-up of 96.5 months. The ablation group had significantly lower complication rates (0.7% vs. 5.2%, P<.001), shorter post-treatment hospitalization (median[IQR], 0 d vs. 4.0[3.0] d, P<.001), shorter procedure time (8.5[2.8] min vs. 90.0[43.8] min, P<.001), reduced estimated blood loss (0 mL vs. 20.0[10.0] mL, P<.001), and lower cost ($1873.2[254.0] vs. $2292.9[797.8], P<.001) than the lobectomy group.

Conclusions: This study revealed comparable disease progression and survival outcomes between ablation and lobectomy for solitary PTMC. Imaged-guided thermal ablation could be effective and safe alternatives to lobectomy for properly selected patients with PTMC.