对于中危型甲状腺乳头状癌，首选的手术方式：甲状腺全切除术还是腺叶切除术？一项系统评价和荟萃分析。

The preferred surgical choice for intermediate-risk papillary thyroid cancer: total thyroidectomy or lobectomy? A systematic review and meta-analysis.

机构信息

Department of General Surgery, Xiangya Hospital, Central South University.

Clinical Research Center for Breast Cancer Control and Prevention in Hunan Province, Changsha.

出版信息

Int J Surg. 2024 Aug 1;110(8):5087-5100. doi: 10.1097/JS9.0000000000001556.

DOI:10.1097/JS9.0000000000001556

PMID:38967517

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11325972/

Abstract

BACKGROUND

The optimal surgical approach for intermediate-risk papillary thyroid carcinoma (IR-PTC) (according to ATA definition), whether total thyroidectomy (TT) or lobectomy (LT), has remained a contentious clinical gray area for several decades. This systematic review and meta-analysis aim to provide robust evidence and address this clinical dilemma comprehensively.

MATERIALS AND METHODS

A comprehensive literature search was conducted in Pubmed, Embase, Web of Science, and the Cochrane Library from 1st January 2009 to 29th December 2023 to evaluate the impact of different surgical options (TT or LT) on patients with IR-PTC. The primary outcomes included survival, recurrence rates, and postoperative complications. I2 and sensitivity analysis was used to explore the heterogeneity.

RESULTS

A total of 8 studies involving 2984 participants were included in this meta-analysis and systematic review. The results indicated that LT was a superior choice for mitigating complications compared to TT [risk ratio (RR), 0.32; 95% CI: 0.24-0.44, P <0.01], particularly for transient complications (RR, 0.24; 95% CI: 0.08-0.65, P <0.01), such as the transient parathyroid dysfunction (RR, 0.04; 95% CI: 0.01-0.15, P <0.01). However, TT did not increase the risk of recurrent laryngeal nerve palsy (RR, 0.78; 95% CI: 0.24-2.47, P =0.67), hemorrhage/seroma (RR, 0.77; 95% CI: 0.48-1.25, P =0.30), and permanent complications (RR, 0.18; 95% CI: 0.02-1.42, P =0.10). Besides, both LT and TT presented similar effect on survival outcomes (overall survival: RR, 1.00; 95% CI: 0.97-1.03, P =0.92, disease-specific survival: RR, 0.99; 95% CI: 0.97-1.02, P =0.69, recurrence-free survival: RR, 1.00; 95% CI: 0.96-1.05, P =0.86), recurrence (RR, 1.05; 95% CI: 0.76-1.46, P =0.76).

CONCLUSION

The present meta-analysis revealed that TT did not yield improved outcomes in IR-PTC patients, but was associated with an increased incidence of temporary complications. In light of these findings, it may be advisable to consider LT as the optimal choice for IR-PTC patients.

摘要

背景

对于中间风险甲状腺乳头状癌（IR-PTC）（根据 ATA 定义），最佳手术方法是甲状腺全切除术（TT）还是甲状腺叶切除术（LT），几十年来一直是一个有争议的临床灰色地带。本系统评价和荟萃分析旨在提供有力的证据，并全面解决这一临床难题。

材料和方法

从 2009 年 1 月 1 日至 2023 年 12 月 29 日，在 Pubmed、Embase、Web of Science 和 Cochrane 图书馆进行了全面的文献检索，以评估不同手术选择（TT 或 LT）对 IR-PTC 患者的影响。主要结局包括生存、复发率和术后并发症。使用 I2 和敏感性分析来探索异质性。

结果

这项荟萃分析和系统评价共纳入了 8 项研究，涉及 2984 名参与者。结果表明，与 TT 相比，LT 是减轻并发症的更好选择[风险比（RR），0.32；95%置信区间：0.24-0.44，P<0.01]，尤其是对于短暂性并发症（RR，0.24；95%置信区间：0.08-0.65，P<0.01），如暂时性甲状旁腺功能障碍（RR，0.04；95%置信区间：0.01-0.15，P<0.01）。然而，TT 并不会增加喉返神经麻痹（RR，0.78；95%置信区间：0.24-2.47，P=0.67）、出血/血清肿（RR，0.77；95%置信区间：0.48-1.25，P=0.30）和永久性并发症（RR，0.18；95%置信区间：0.02-1.42，P=0.10）的风险。此外，LT 和 TT 对生存结局的影响相似（总生存：RR，1.00；95%置信区间：0.97-1.03，P=0.92，疾病特异性生存：RR，0.99；95%置信区间：0.97-1.02，P=0.69，无复发生存：RR，1.00；95%置信区间：0.96-1.05，P=0.86），复发（RR，1.05；95%置信区间：0.76-1.46，P=0.76）。