Completion Thyroidectomy Trends and Rates: A Systematic Review and Meta-Analysis

Background: In January 2016, the American Thyroid Association (ATA) published an update to the guidelines concerning the management of adult patients with thyroid nodules and well-differentiated thyroid cancers. One of the revised recommendations states that lobectomy is a reasonable surgical approach for low-risk patients. This systematic review compares the rates of completion thyroidectomy surgeries before and after the publication of the recent ATA guidelines. Methods: A systematic review was conducted according to the PRISMA guidelines of the preferred reporting items for systematic reviews and meta-analyses. PubMed and Embase databases were searched to find articles which demonstrate the rates of completion thyroidectomy surgeries in the last 6 years, before and after the recent ATA guidelines publication. Overall, 8744 titles and abstracts were screened, and 964 articles were fully assessed for eligibility. Eventually, 40 studies were included for data extraction. More than 48 000 patients with thyroid malignancy were included in the review, and were divided into three time periods according to the publication date of 2015 ATA guidelines. Results: We found that the rate of completion thyroidectomy was 51.8% before 2016 and 43.1% after the 2015 ATA guidelines publication. We observed a 17% reduction of early completion thyroidectomy surgeries since the 2015 ATA guidelines publication relative to previous periods, among patients with malignant pathology. Conclusions: Apparently, more centres worldwide implemented the new guidelines and prefer a conservative surgical approach as compared to the pre-ATA 2015 era.