Active surveillance in low risk papillary thyroid carcinoma

Table 1 Postoperative adverse events of thyroid surgery in a cohort of 14934 patients[28]

Postoperative adverse eventFrequency (%)	Total thyroidectomy	Lobectomy
Hypoparathyroidism (10%)
Transient	14%	0.4%
Permanent	2.2%	0.07%
Vocal cord paralysis (3.4%)
Transient	2.4%	1.4%
Permanent	1.3%	0.6%
Bilateral	0.6%	0%
Hematoma (1.2%)	1.6%	0.4%
Surgical wound infection (0.3%)	0.4%	0.13%
External superior laryngeal nerve injury	0.4%
Thoracic duct injury	0.2%
Ulnar nerve injury	0.2%
Others1	0.9%

¹Other complications: Claude-Bernard-Horner syndrome, punctate keratitis, alterations caused by neck hyperextension during surgery: vertigo, headache, nausea.

Table 2 Unfavorable events following active surveillance and immediate surgery (adapted from Oda et al[27], 2018)

Complication	Active surveillance	Immediate surgery	P value
Vocal cord paralysis			< 0.0001
Transient	0.6%	4.1%
Permanent	0%	0.2%
Hypoparathyroidism			< 0.0001
Transient	2.8%	16.7%
Permanent	0.08%	1.6%
Hypothyroidism	0.08%	1.6%	< 0.0001
Levothyroxine requirement	20.7%	66%
Hematoma	0%	0.5%	< 0.05

Table 3 Highlighted active surveillance trials

Ref.	n	Median follow-up in mo	Tumor growth ≥ 3 mm, % patients	Lymph node metastasis, % patients	Distant metastases, % patients	Deaths, % patients
Sugitani et al[44], 2010	230	5	9.6	1.3	0	0
Ito et al[6], 2014	1235	120	8	3.8	0	0
Oda et al[27], 2016	1179	36	2.3	0.5	0	0
Kwon et al[74], 2017	192	30	14	0.5	0	0
Tuttle et al[17], 2017	291	25	3.8	0	0	0
Kim et al[52], 2018	126	26	5.6	0.8	0	0
Sakai et al[47], 2018	61	88.8	7	3	0	0
Smulever and Pitoia[8], 2019	34	42	17	0	0	0
Molinaro et al[75], 2019	93	19	2.1	1	0	0