Active surveillance of low-risk papillary thyroid cancer: 2100/4200 patients opted for surgery instead of AS in this study!

Active surveillance of low-risk papillary thyroid cancer: 2100/4200 patients opted for surgery instead of AS in this study!

Active surveillance AS  of low-risk papillary thyroid cancer: 2100/4200 patients opted for surgery in this study! How many would opt out of surgery and switch to radiofrequency ablation if it was offered as a third alernative to AS?

Dr.Guttler’s comments

  1. Because the patients were only given Surgery or AS as alternatives, the main indication for surgery was patient preference, not disease progression, at 51.9% (95% confidence interval 44.9–58.9%).
  2. Would the patients  choose radiofrequency ablation over surgery or AS?
  3. 50% of the study group of 4200 patients in 9 studies decided to have invasive surgery to observation by AS for many years.
  4. They were not given a third option before they had to decide.
  5. There is a strong desire of patients to rid their body of the small cancer even though it is low risk for enlarging or spreading and no risk of dying in the 9 study groups.
  6. Contact me at 310-393-8860 or [email protected]
  7. DR.G.

Active surveillance of low-risk papillary thyroid cancer: A meta-analysis

 
Surgery, Volume 168, Issue 5, November 2020, Pages 975
Se Jin Cho, Jung Hwan Baek

Re: “Active surveillance of low-risk papillary thyroid cancer: A meta-analysis”

Surgery, Volume 167, Issue 5, May 2020, Pages 885-886

Abstract

Background

This study evaluates the safety and efficacy of active surveillance for low-risk papillary thyroid carcinoma.

Methods

MEDLINE, EMBASE, and PubMed were searched from inception for relevant studies of active surveillance for low-risk papillary thyroid carcinoma, defined as T1a or T1b, N0, M0 disease. Main outcomes of interest were growth of primary tumor, metastatic spread, thyroid cancer-related mortality, and disease recurrence after delayed thyroid surgery.

Results

Nine publications with 4,156 patients were included. Primary analysis of the 9 studies revealed pooled proportion of tumor growth during active surveillance to be 4.4% (95% confidence interval 3.2–5.8%). The pooled rate of metastatic spread to cervical nodes was 1.0% (95% confidence interval 0.7–1.4%), and pooled mortality due to thyroid cancer was 0.03% (95% confidence interval 0.0005–0.2%). Eight studies assessed incidence of delayed thyroid surgery with pooled proportion of 9.9% (95% confidence interval 6.4–14.0%). The main indication for surgery was patient preference, not disease progression, at 51.9% (95% confidence interval 44.9–58.9%). The pooled proportion of recurrence after delayed thyroid surgery was 1.1% (95% confidence interval 0.1–3.8%).

Conclusion

Active surveillance appears to be a safe alternative to surgery for the management of low-risk papillary thyroid carcinoma, without increased risk of recurrence or death. This strategy allows for avoidance of exposure to surgical risk and need for subsequent thyroid replacement therapy.

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