One- or Two-Step Total Thyroidectomy for Cancer Indications: A 20-Year Retrospective Study from a Referral Center

The ATA guidelines suggest lobectomy as an option for select patients with thyroid cancer (TC), but some may need completion thyroidectomy because of unfavorable characteristics on the final pathology. This study aimed to compare postoperative morbidity of patients with TC who underwent total thyroidectomy in two steps (TT2) or one step (TT1).

This was a retrospective comparative study in a high-volume endocrine surgery center. All consecutive adult patients who underwent total thyroidectomy in one step (TT1 group) or two steps (TT2 group) for follicular, oncocytic, or papillary TC between 2000 and 2020 were included. Surgical complications were compared between the two groups using propensity score matching, with a 2:1 allocation, according to age, sex, BMI, tumor stage, lymph node dissection, and year of surgery.

In total, 5693 patients were enrolled, with 684 with TT2 and 5009 with TT1. Following adjustment, TT2 patients had significantly lower rates of transient hypocalcemia than TT1 patients did (3.2% versus 13.8%, p < 0.001). There was no significant difference in permanent hypocalcemia (2.1% versus 1.3%, p = 0.290), transient or permanent recurrent laryngeal nerve (RLN) injury (2.3% versus 3.5%, p = 0.201; 1.3% versus 1.3%, p = 0.998), hematoma (0.9% versus 1.2%, p = 0.591), or wound infection rates (0% versus 0.7%, p = 0.062).

Total thyroidectomy in two steps for thyroid cancer can be performed safely, with short- and long-term complications at least similar to those of total thyroidectomy in one step.