TOPLINE:

Lobectomy was associated with oncologic outcomes comparable to those of total thyroidectomy in patients with sporadic medullary thyroid cancer. Mortality, biochemical cure (serum calcitonin levels within the normal range), and development of distant metastases did not differ between the two surgical approaches; however, postoperative complications were more prevalent in the total thyroidectomy group.

METHODOLOGY:

• Although total thyroidectomy remains the standard recommendation in most guidelines, high-quality evidence demonstrating its superiority in sporadic medullary thyroid cancer remains limited.
• Researchers conducted a systematic review and meta-analysis of comparative studies evaluating patients with sporadic medullary thyroid cancer who underwent total thyroidectomy or lobectomy to compare oncologic outcomes between the two procedures.
• A total of 1371 patients from nine retrospective studies were included: 531 (38.7%) underwent lobectomy and 840 (61.3%) underwent total thyroidectomy; central neck dissection was performed in 445 of 492 patients (90.4%).
• Primary outcomes were mortality, overall survival, structural recurrence (detection of at least one solid lesion on cross-sectional imaging after surgery), biochemical cure, and development of distant metastases; the secondary outcome was postoperative complications.

TAKEAWAY:

• At 5 years, mortality did not differ between lobectomy and total thyroidectomy (relative risk [RR], 0.30; 95% CI, 0.07-1.35), and mortality outcomes remained similar between both approaches even after 5 years.
• Overall survival was also similar between the two procedures (RR, 1.02; 95% CI, 0.94-1.11).
• Analyses of four studies for recurrence and biochemical cure and two studies for distant metastases showed no superiority of total thyroidectomy for any outcome at 5 years.
• Postoperative complications were more frequently observed in patients undergoing total thyroidectomy than in those undergoing lobectomy.

IN PRACTICE:

“The findings of this review, taken from the majority of the included articles, suggest that in carefully selected patients, lobectomy with appropriate central neck dissection may provide oncologic outcomes comparable to those of total thyroidectomy,” the authors wrote.

SOURCE:

The study was led by Eddy P. Lincango, MD, MSc, Cancer de Tiroides en Latino América, Quito, Ecuador. It was published online on in JAMA Otolaryngology-Head & Neck Surgery.

LIMITATIONS:

All included studies were retrospective, making them susceptible to selection bias, incomplete data capture, and unmeasured confounding. The rarity of medullary thyroid cancer rendered large prospective randomized trials unlikely, and sample sizes varied widely. Long-term outcomes were underreported, as few studies extended follow-up beyond 5 years.

DISCLOSURES:

One author disclosed serving as a member of the data monitoring committee of the Medullary Thyroid Cancer Consortium Registry, which receives support from Novo Nordisk, AstraZeneca, and Eli Lilly as well as institutional research funding from Exelixis and Eli Lilly.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.