Hemithyroidectomy versus total thyroidectomy for well differentiated T1–2 N0 thyroid cancer: systematic review and meta-analysis
A partir d'une revue systématique de la littérature (10 études incluant au total 23 134 patients), cette méta-analyse compare l'intérêt, du point de vue des complications, du taux de récidive et du taux de survie globale à 20 ans, d'une hémithyroïdectomie et d'une thyroïdectomie totale en combinaison ou non avec de l'iode radioactif chez les patients atteints d'un cancer papillaire ou folliculaire de la thyroïde de stade T1-2 N0
Background : Evidence for limiting the extent of surgery in patients with low‐risk thyroid cancer is lacking. Methods : A systematic search was performed according to the PRISMA and MOOSE guidelines to assess the effect of total thyroidectomy (TT) with or without radioactive iodine (RAI) treatment versus hemithyroidectomy (HT) on recurrence and overall mortality in patients with differentiated (papillary or follicular) T1–2 N0 thyroid cancer. PubMed, Embase and Cochrane databases were searched, and two authors independently assessed the articles. Results : A total of ten eligible articles were identified. All were observational cohort series, representing a total of 23 134 patients, of which 17 699 were available for meta‐analysis. Six studies included patients who had TT followed by RAI treatment. The pooled recurrence rate after TT ± RAI and HT was 2·3 and 2·8 per cent respectively (odds ratio (OR) 1·12, 95 per cent c.i. 0·82 to 1·53; P = 0·48). The pooled 20‐year overall survival rate after TT ± RAI was 96·8 per cent, compared with 97·4 per cent for HT (OR 1·30, 0·71 to 2·37; P = 0·40). Overall, higher complication rates were found in the TT ± RAI group. Conclusion : Recurrence rates after HT for treatment of well differentiated T1–2 N0 thyroid cancer were similar to those after TT ± RAI, with a lower incidence of treatment‐related complications.
BJS Open 2020