The optimal surgical approach for differentiated thyroid cancer remains controversial, with debate regarding the comparative risks of upfront total thyroidectomy versus staged completion thyroidectomy following the initial lobectomy. This study aimed to assess the complication rates associated with these two strategies and identify the optimal timing for completion thyroidectomy using a multi-dimensional analysis of four cohorts: an institutional series (n= 148), the National Surgical Quality Improvement Program (NSQIP) database (n= 39,992), the TriNetX repository (n> 30,000), and a pooled literature review (10 studies,n= 6015). Institutional data revealed higher overall complication rates with total thyroidectomy (18.3%) compared to completion thyroidectomy (6.8%), primarily due to increased temporary hypocalcemia (10% vs. 0%,p= 0.004). The NSQIP analysis demonstrated that total thyroidectomy was associated with a 72% increased risk of transient hypocalcemia (p< 0.001) and a 25% increased risk of permanent hypocalcemia (p< 0.001). TriNetX data confirmed these findings and identified obesity and concurrent neck dissection as risk factors for complications. A meta-analysis showed that total thyroidectomy increased the rates of transient (RR = 1.63) and permanent (RR = 1.23) hypocalcemia (p< 0.001). Institutional and TriNetX data suggested that performing completion thyroidectomy between 1 and 6 months after the initial lobectomy minimized permanent complication rates compared to delays beyond 6 months. In conclusion, for differentiated thyroid cancer, total thyroidectomy is associated with higher risks of transient and permanent hypocalcemia compared to staged completion thyroidectomy. However, performing completion thyroidectomy within 1–6 months of the initial lobectomy may mitigate the risk of permanent complications. These findings can inform personalized surgical decision-making for patients with differentiated thyroid cancer.
分化型甲状腺癌的最佳手术方式仍存争议，焦点在于一期全甲状腺切除术与甲状腺叶切除术后分期完成甲状腺切除术的风险比较。本研究通过多维度分析四个队列数据——机构病例系列（n=148）、美国外科手术质量改进计划（NSQIP）数据库（n=39,992）、TriNetX医疗数据平台（n>30,000）及文献荟萃分析（10项研究，n=6015），旨在评估两种策略的并发症发生率并确定完成甲状腺切除术的最佳时机。机构数据显示，全甲状腺切除术总体并发症发生率（18.3%）高于完成甲状腺切除术（6.8%），主要归因于暂时性低钙血症发生率增加（10% vs. 0%，p=0.004）。NSQIP分析表明，全甲状腺切除术使暂时性低钙血症风险增加72%（p<0.001），永久性低钙血症风险增加25%（p<0.001）。TriNetX数据验证了上述发现，并确定肥胖及同期颈淋巴结清扫是并发症的危险因素。荟萃分析显示全甲状腺切除术显著提高暂时性（RR=1.63）与永久性（RR=1.23）低钙血症发生率（p<0.001）。机构与TriNetX数据提示，与延迟超过6个月相比，在初次甲状腺叶切除术后1-6个月内行完成甲状腺切除术可最大限度降低永久性并发症风险。综上，对于分化型甲状腺癌，全甲状腺切除术比分阶段完成甲状腺切除术具有更高的暂时性与永久性低钙血症风险。然而，在初次甲状腺叶切除术后1-6个月内实施完成甲状腺切除术可能降低永久性并发症风险。这些发现可为分化型甲状腺癌患者的个体化手术决策提供依据。
肿瘤(癌症)患者之家