Department of Head and Neck Surgery, Kuma Hospital, Kobe, Japan.
Department of Surgery, Kuma Hospital, Kobe, Japan.
Thyroid. 2023 Feb;33(2):186-191. doi: 10.1089/thy.2022.0444. Epub 2022 Nov 8.
Active surveillance (AS) for low-risk papillary thyroid microcarcinoma (PTMC) was initiated at Kuma Hospital in 1993 and has gradually spread worldwide. We previously demonstrated that AS is associated with a much lower incidence of unfavorable events than immediate surgery (IS). However, conversion surgery (CS) raises concerns about increased surgical complications due to advanced disease. In this study, we conducted a comparative analysis of unfavorable events after IS and CS. Between 2005 and 2019, 4635 patients clinically diagnosed with low-risk PTMC at Kuma Hospital were enrolled. Of these, 2896 underwent AS (AS group), and the remaining 1739 underwent IS (IS group). To date, 242 patients (0.8%) in the AS group have undergone CS for various reasons (CS group). The incidence of unfavorable events, such as levothyroxine administration after surgery, postoperative hematoma, transient/persistent hypoparathyroidism, and transient/persistent vocal cord paralysis, did not differ between the CS and IS groups. None of the patients in the CS group had permanent vocal cord paralysis; however, this occurred in 15 patients (0.9%) in the IS group and was caused by accidental injury in 4 patients and carcinoma invasion in 11 patients. The incidence of surgery, levothyroxine administration, postoperative hematoma, transient/permanent hypoparathyroidism, and vocal cord paralysis was significantly higher ( < 0.001) in the IS group than in the AS group. There were no differences in the incidence of lymph node recurrence and overall mortality between the AS and IS groups. None of the patients in the AS and IS groups showed distant metastasis or died from thyroid carcinoma. There were no differences in the incidence of unfavorable events between the CS group and the IS group. Although none of the CS and AS groups had permanent vocal cord paralysis, accidental injury of the recurrent laryngeal nerve occurred in four patients (0.2%) in the IS group. The IS group had a significantly higher incidence of unfavorable events than the AS group. The prognoses of patients in both the AS and IS groups were excellent. Therefore, we recommend AS as the first-line management for low-risk PTMC.
主动监测（AS）用于低危型甲状腺微小乳头状癌（PTMC）始于 1993 年的久留米医院，并逐渐在全球范围内传播。我们之前的研究表明，AS 与立即手术（IS）相比，不良事件的发生率要低得多。然而，转化手术（CS）由于疾病的进展，增加了手术并发症的担忧。在这项研究中，我们对 IS 和 CS 后的不良事件进行了比较分析。2005 年至 2019 年间，在久留米医院临床诊断为低危型 PTMC 的 4635 例患者被纳入研究。其中，2896 例患者接受 AS（AS 组），其余 1739 例患者接受 IS（IS 组）。迄今为止，AS 组中有 242 例（0.8%）患者因各种原因接受 CS（CS 组）。手术后服用甲状腺素、术后血肿、一过性/永久性甲状旁腺功能减退、一过性/永久性声带麻痹等不良事件的发生率在 CS 组和 IS 组之间无差异。CS 组中没有患者发生永久性声带麻痹；然而，IS 组中有 15 例（0.9%）患者发生这种情况，其中 4 例是由意外伤害引起的，11 例是由癌侵犯引起的。手术、服用甲状腺素、术后血肿、一过性/永久性甲状旁腺功能减退和声带麻痹的发生率在 IS 组显著高于 AS 组（<0.001）。AS 组和 IS 组的淋巴结复发和总死亡率无差异。AS 组和 IS 组均无远处转移或死于甲状腺癌。CS 组和 IS 组的不良事件发生率无差异。AS 组和 IS 组均无永久性声带麻痹，但 IS 组有 4 例（0.2%）患者出现喉返神经意外伤害。IS 组不良事件发生率显著高于 AS 组。AS 组和 IS 组患者的预后均良好。因此，我们建议将 AS 作为低危型 PTMC 的一线治疗方法。
