Randomized clinical trials

Schiavone D, Crimì F, Cabrelle G, Pennelli G, Sacchi D, Mian C et al.

Br J Surg 2024; 111: znae196.

In this study that included 56 patients, preoperative use of Lugol’s significantly reduced T3 and T4 levels, but had no effect on clinical outcomes, including blood loss (80.5 versus 94ml with no Lugols’s) and duration of surgery.

Comment: Is the trial large enough to wave goodbye to Lugol’s?

Koh J-M, Song K, Kwak MK, Suh S, Kim B-J, Sung T-Y et al.

Ann Surg 2024; 279: 945-952.

This study included 132 patients with an asymptomatic incidental adrenaloma, but raised serum cortisol. Adrenalectomy improved weight control and diabetes control (both P=0.002) compared with the control group.

Comment: Good evidence upon which to base treatment in these patients.

Chen L, He Q, Tian H, Zhu Q, Shen Y, Fang Y et al.

Int J Surg 2023; 109: 2672-2679.

Two different surgical approaches were assessed in 220 patients having surgery for unilateral thyroid cancer. Both incisions were safe and effective, but the sternomastoid incision resulted in less discomfort in the first month (P=0.02), and improved cosmesis from an observer viewpoint.

Comment: The lateral approach for a hemithyroidectomy could have advantages over the standard transverse incision.

Kiernan C, Thomas G, Patel A, Fan R, Ye F, Willmon P et al.

Ann Surg 2023; 278: 549-558.

In this study that included 160 procedures, use of the probe improved the parathyroid detection rate by an experienced surgeon (3.6 versus 3.2 per procedure, P<0.001), and reduced the number of frozen section procedures required (17 versus 47, P=0.005). Detection rates were better for trainees than experienced surgeons.

Comment: Useful, but is it generalizable?

Sanabria A, Betancourt-Agüero C, Sánchez-Delgado J, García-Lozano C.

Ann Surg 2022; 276: 66-73.

There were five RCTs with 763 treated patients. Rates of recurrence were similar: 2.7 per cent after additional node dissection and 2.5 per cent after thyroidectomy alone. Node dissection increased the rate of permanent hypoparathyroidism: risk difference 3 per cent.

Comment; This result seems definitive.

Ahn J-H, Kwak JH, Yoon SG, Yi JW, Yu HW, Kwon H et al.

Surgery 2022; 171: 182-189.

Central lymph node dissection improved the yield of positive nodes in this study of 101 procedures, without affecting complication rates. No patient had a recurrence up to four years after surgery.

Comment: This study is too small to provide answers in the long term.

Leboulleux S, Bournaud C, Chougnet CN, Zerdoud S, Al Ghuzlan, Catargi B et al.

N Engl J Med 2022; 386:923-932.

In this study that included 730 patients, there was no difference in structural or functional outcomes up to three years.

Comment: Too early to conclude much, but a good sized group for longer follow-up.