Hemithyroidectomy under local anaesthesia as the initial definite treatment for papillary thyroid carcinoma: a propensity score analysis

Abstract Objective The latest trend in the surgical management of low‐risk differentiated thyroid carcinomas is de‐escalation, with lobectomy performed for low‐risk cases due to their excellent prognosis. Thyroidectomy for selected nodules under local anaesthesia (LA) is generally safe. This study was undertaken to investigate whether LA thyroidectomy is equally effective for selected cases of papillary thyroid carcinoma (PTC). Methods Twenty‐five patients with histopathologically verified PTC who underwent LA hemithyroidectomy as initial definite therapy were retrieved from the in‐house thyroid cancer registry. Their clinicopathologic data, operation status (day vs inpatient), surgical complications (vocal cord palsy, post‐operative haematoma, and wound complications), and oncologic outcomes (tumour recurrence and survival) were evaluated. Post‐operative thyroglobulin monitoring and radioactive iodine ablation were not practised after hemithyroidectomy. Propensity score matching was utilised to compare operation outcomes with the general anaesthesia counterpart ( N = 112). Results The median follow‐up was 87.0 months, and the median tumour diameter was 6.0 mm (range 1.0–40.0 mm). Twelve (48%) tumours were incidental, while 13 (52%) were non‐incidental. Most patients (84%) were discharged as day cases. Regarding surgical complications, only one case of permanent vocal cord palsy occurred, with no incidence of transient cord palsy, wound swelling, unplanned readmission, or wound infection. Three patients underwent completion thyroidectomy in due course. There was no tumour recurrence or cancer‐specific mortality in this series. Length of stay ( P = .0002), unplanned readmission ( P < .0001), and overall thyroidectomy complications ( P < .0001) were significantly lower in the LA arm by propensity score matching analysis. Conclusions For low‐ and selected intermediate‐risk PTC, LA hemithyroidectomy appears to be safe in the long run. Its benefits include early recovery, a short hospital stay, the feasibility of day surgery, and simplified post‐operative care by eliminating thyroglobulin monitoring and long‐term thyroxine usage.