Thyroid Cancer: Thermal Ablation vs Surgery at Five Years
Key Takeaways
- Among patients with T1N0M0 papillary thyroid carcinoma in the danger triangle at two centers in China, progression was 6% with TA versus 4.8% with SR, without a significant difference.
- Disease-free survival was 94.1% with TA versus 95.2% with SR, without a significant difference.
- Overall complications were 6% with TA versus 16.7% with SR, and major complications were 0% versus 7.1%, respectively; both were significantly less frequent after TA.
- Hospital stays and procedures were shorter, and blood loss was lower, after TA than after SR.
Investigators at two centers in China retrospectively compared ultrasound-guided thermal ablation (TA) with surgical resection (SR) in the matched cohort. Treatments occurred from September 2016 through April 2020. Of 470 records reviewed, 194 patients were eligible; propensity matching yielded 84 patients per group, with median follow-up of 68 months after TA and 67 months after SR. Eligibility required at least 60 months of follow-up and one pathologically confirmed T1N0M0 lesion no larger than 2 cm in the danger triangle, without imaging evidence of extrathyroidal extension, nodal involvement, or distant spread. TA used radiofrequency or microwave energy with hydrodissection to separate tumors from nearby structures. SR involved lobectomy or total thyroidectomy with prophylactic central neck dissection. Investigators assessed progression, disease-free survival (DFS), complications, and treatment burden.
Progression occurred in five patients after TA and four after SR (P=0.732); reported components included regional nodal metastasis, local tumor progression, and residual tumor. DFS also did not differ significantly (P=0.898).
Overall complications occurred in five patients after TA and 14 after SR (P=0.049). Major complications occurred only after SR (P=0.028). Hospital stay, procedure time, and blood loss were also significantly lower with TA.
Patients selected treatment nonrandomly, leaving potential unmeasured confounding despite propensity matching. Operative extent varied, and prophylactic central neck dissection could have influenced surgical complication rates. TA combined radiofrequency and microwave techniques performed by experienced operators, while early imaging schedules differed between groups. With few progression events, a limited matched cohort, and no prespecified sample-size calculation, the nonsignificant oncologic comparisons cannot establish equivalence or noninferiority.
The authors reported no statistically significant difference in observed oncologic outcomes between the selected groups, while TA was associated with fewer complications and less procedural burden.
Clinician Questions
When was thermal ablation offered instead of surgery for thyroid danger-triangle papillary carcinoma?
In the two-center Chinese cohort of patients with T1N0M0 papillary thyroid carcinoma in the danger triangle, surgery was the preferred routine treatment; ultrasound-guided thermal ablation was offered when patients were unsuitable for surgery or declined it. That selection criterion describes the cohort, not a treatment recommendation.
Which permanent complications occurred after surgery for thyroid danger-triangle papillary carcinoma?
Among surgical recipients with T1N0M0 papillary thyroid carcinoma in the danger triangle, four experienced permanent hoarseness and two experienced permanent hypoparathyroidism. Both patients with permanent hypoparathyroidism had undergone total thyroidectomy. No major complications of these types occurred after thermal ablation in the matched cohort.
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