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Effect of the COVID-19 Pandemic on Surgery for Indeterminate Thyroid Nodules (THYCOVID): a Retrospective, International, Multicentre, Cross-Sectional Study

Fabio Medas,Chiara Dobrinja,Ebtesam Abdullah Al-Suhaimi,Julia Altmeier,Said Anajar,Akif Enes Arikan,Irina Azaryan,Lovenish Bains,Giancarlo Basili,Hakan Bolukbasi,Marco Bononi,Farzad Borumandi,Mehmet Bugra Bozan,Gabriela Brenta,Laurent Brunaud,Maximilian Brunner, Antoine Buemi,Gian Luigi Canu,Federico Cappellacci, Burchfield Cartwright, Ignasi Castells Fuste,Beatriz Cavalheiro,Giuseppe Cavallaro,Andres Chala,Shun Yan Bryant Chan,John Chaplin,Mustafa Sajjad Cheema,Costanza Chiapponi,Maria Grazia Chiofalo,Emmanuel Chrysos,Annamaria D'Amore,Michael de Cillia,Carmela De Crea,Nicolo de Manzini,Leandro Luongo de Matos,Loredana De Pasquale,Paolo Del Rio,Marco Stefano Demarchi,Muthuswamy Dhiwakar,Gianluca Donatini,Jose Miguel Dora,Valerio D'Orazi, Viyey Kishore Doulatram Gamgaram,Vitalijus Eismontas,El Hassane Kabiri,Hadj Omar El Malki,Islam Elzahaby,Octavian Enciu,Antoine Eskander,Francesco Feroci, David Figueroa-Bohorquez,Dimitrios Filis,Gorostidi Francois,Pedro Frias-Fernandez, Armando Gamboa-Dominguez,Volkan Genc,Davide Giordano,Antonio Gomez-Pedraza,Giuseppa Graceffa,James Griffin, Sofia Cuco Guerreiro, Karan Gupta,Keshav Kumar Gupta,Angela Gurrado,Jiannis Hajiioannou,Tommi Hakala,Wirsma Arif Harahap,Lindsay Hargitai,Dana Hartl,Andrzej Hellmann,Jiri Hlozek,Van Trung Hoang,Maurizio Iacobone,Nadia Innaro,Orestis Ioannidis,J. H. Isabelle Jang,Jose Candido Xavier-Junior,Milan Jovanovic,Reto Martin Kaderli,Fahmi Kakamad,Krzysztof Kaliszewski,Martin Karamanliev,Hiroshi Katoh,Andro Kosec,Bozidar Kovacevic,Luiz Paulo Kowalski,Robert Kralik,Sanjay Kumar Yadav, Adriana Kumorova,Savvas Lampridis,Konstantinos Lasithiotakis,Jean-Christophe Leclere,Eugene Kwong Fei Leong, Melvin Khee-Shing Leow,James Y. Lim,Leonardo S. Lino-Silva,Shirley Yuk Wah Liu, Nuria Perucho Llorach,Celestino Pio Lombardi,Javier Lopez-Gomez,Eleonora Lori,Lourdes Quintanilla-Dieck,Roberta Lucchini,Amin Madani,Dimitrios Manatakis,Ivan Markovic,Gabriele Materazzi,Haggi Mazeh,Giuseppe Mercante,Goswin Yason Meyer-Rochow,Olgica Mihaljevic,Julie A. Miller,Michele Minuto,Massimo Monacelli,Francesk Mulita,Barbara Mullineris,Jose Luis Munoz-de-Nova,Fabio Muradas Girardi, Saki Nader,Tangjaturonrasme Napadon,Constantinos Nastos,Chiara Offi,Ohad Ronen,Luigi Oragano,Aida Orois,Yongqin Pan,Emmanouil Panagiotidis,Ramakanth Bhargav Panchangam,Theodosios Papavramidis,Pradipta Kumar Parida,Anna Paspala,Oscar Vidal Perez,Sabrina Petrovic,Marco Raffaelli,Constanza Fernanda Ramacciotti,Tomas Ratia Gimenez, Angel Rivo Vazquez,Jong-Lyel Roh,Leonardo Rossi,Alvaro Sanabria,Alena Santeerapharp,Arseny Semenov,Sanjeewa Seneviratne,Altinay Serdar, Patrick Sheahan,Sean C. Sheppard,Rachel L. Slotcavage,Constantin Smaxwil,Soo Young Kim,Salvatore Sorrenti, Eleftherios Spartalis,Chutintorn Sriphrapradang,Mario Testini,Yigit Turk,George Tzikos, Kristina Vabalayte,Kelly Vargas-Osorio, Rafael Sebastian, Vazquez Renteria,David Velazquez-Fernandez,Sanura Malinda Pallegoda Vithana,Levent Yucel,Erwin Danil Yulian,Petra Zahradnikova,Paul Zarogoulidis, Evgeniia Ziablitskaia, Anna Zolotoukho,Pietro Giorgio Calo

˜The œLancet Diabetes & endocrinology(2023)

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摘要
Background Since its outbreak in early 2020, the COVID-19 pandemic has diverted resources from non-urgent and elective procedures, leading to diagnosis and treatment delays, with an increased number of neoplasms at advanced stages worldwide. The aims of this study were to quantify the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic; and to evaluate whether delays in surgery led to an increased occurrence of aggressive tumours. Methods In this retrospective, international, cross-sectional study, centres were invited to participate in June 22, 2022; each centre joining the study was asked to provide data from medical records on all surgical thyroidectomies consecutively performed from Jan 1, 2019, to Dec 31, 2021. Patients with indeterminate thyroid nodules were divided into three groups according to when they underwent surgery: from Jan 1, 2019, to Feb 29, 2020 (global prepandemic phase), from March 1, 2020, to May 31, 2021 (pandemic escalation phase), and from June 1 to Dec 31, 2021 (pandemic decrease phase). The main outcomes were, for each phase, the number of surgeries for indeterminate thyroid nodules, and in patients with a postoperative diagnosis of thyroid cancers, the occurrence of tumours larger than 10 mm, extrathyroidal extension, lymph node metastases, vascular invasion, distant metastases, and tumours at high risk of structural disease recurrence. Univariate analysis was used to compare the probability of aggressive thyroid features between the first and third study phases. The study was registered on ClinicalTrials.gov, NCT05178186. Findings Data from 157 centres (n=49 countries) on 87 467 patients who underwent surgery for benign and malignant thyroid disease were collected, of whom 22 974 patients (18 052 [78 center dot 6%] female patients and 4922 [21 center dot 4%] male patients) received surgery for indeterminate thyroid nodules. We observed a significant reduction in surgery for indeterminate thyroid nodules during the pandemic escalation phase (median monthly surgeries per centre, 1 center dot 4 [IQR 0 center dot 6-3 center dot 4]) compared with the prepandemic phase (2 center dot 0 [0 center dot 9-3 center dot 7]; p<0 center dot 0001) and pandemic decrease phase (2 center dot 3 [1 center dot 0-5 center dot 0]; p<0 center dot 0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69 center dot 0%] of 3704 vs 1515 [71 center dot 5%] of 2119; OR 1 center dot 1 [95% CI 1 center dot 0-1 center dot 3]; p=0 center dot 042), lymph node metastases (343 [9 center dot 3%] vs 264 [12 center dot 5%]; OR 1 center dot 4 [1 center dot 2-1 center dot 7]; p=0 center dot 0001), and tumours at high risk of structural disease recurrence (203 [5 center dot 7%] of 3584 vs 155 [7 center dot 7%] of 2006; OR 1 center dot 4 [1 center dot 1-1 center dot 7]; p=0 center dot 0039). Interpretation Our study suggests that the reduction in surgical activity for indeterminate thyroid nodules during the COVID-19 pandemic period could have led to an increased occurrence of aggressive thyroid tumours. However, other compelling hypotheses, including increased selection of patients with aggressive malignancies during this period, should be considered. We suggest that surgery for indeterminate thyroid nodules should no longer be postponed even in future instances of pandemic escalation. Funding None. Copyright (c) 2023 Published by Elsevier Ltd. All rights reserved.
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