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Original Research

Ho AS, Davies L, Yeh MW. Active Surveillance and Conversion Surgery for Low-Risk Thyroid Cancer-The Disconnect Between Literature and Practice. JAMA Otolaryngol Head Neck Surg. 2024 May 15. doi: 10.1001/jamaoto.2024.1702. Epub ahead of print. PMID: 38749063.

DoM Author(s):
Michael W. Yeh, MD

Abstract (When available):

In this issue of JAMA Otolaryngology–Head & Neck Surgery, Levyn et al¹ report on conversion surgery for patients with low-risk papillary thyroid cancer (PTC) undergoing active surveillance (AS). Also known as delayed or rescue surgery, conversion surgery is an established part of the AS framework, one that to date has been perhaps underacknowledged. Most patients who undergo AS remain under observation, but a minority of people will require or desire intervention. Much debate has been made about the theoretical risks of delaying intervention: will there be upstaging, growth that unnecessarily jeopardizes important structures, and poorer outcomes? This study quells some of these concerns.

Of 550 patients undergoing AS in the study cohort, 55 (10.0%) underwent thyroidectomy over time, of which 39 (7.1%) had surgery for disease progression. Conversion occurred after a median (IQR) of 28 (16-68) months of observation. The authors also compared conversion surgery with a propensity score–matched cohort of patients with PTC treated conventionally with immediate surgery. The authors showed equivalent outcomes between the 2 groups, related to extent of surgery, complication rates, and most importantly, recurrence risk. This is encouraging. These findings support AS as a durable and safe management approach. It also suggests that AS is sensible: a patient had a 9 in 10 chance of not needing surgery and lost little to nothing if they were the 1 in 10 that convert. There is a clear and safe exit strategy.