Canadian Association of General Surgeons Evidence Based Reviews in surgery. 4. Decision analysis of total thyroidectomy versus thyroid lobectomy in low-risk, differentiated thyroid cancer.

Question: What is the best surgical approach for low-risk, differentiated thyroid cancer? Design: Decision analysis using a simple decision tree. Base case: A patient with a localized, well-differentiated thyroid cancer. Treatment alternatives: Total or near-total thyroidectomy or thyroid lobectomy. Outcomes considered: Risk of surgical complications, recurrence and death after 10 years’ follow-up. Sources of estimates for probabilities and utilities: Baseline probabilities were “weighted averages” generated from a review of mainly retrospective reviews plus the authors’ experience with 156 patients. Utilities (quantitative measures of the value that a person places on a certain health state) were derived from a survey of their own patients. Results: Total or near-total thyroidectomy is favoured with a utility of 0.876 compared with a utility of 0.741 for lobectomy. Sensitivity analyses: Total or near-total thyroidectomy remains the preferred strategy unless the risk of recurrence is the same after both procedures or the risk of a complication is 33 times greater for total or near-total thyroidectomy. Also, the patient’s utilities for risk of recurrence and surgical complications affect the model. Conclusion: Total or near-total thyroidectomy is the preferred treatment for localized, well-differentiated thyroid cancer.