Thermal ablation versus surgical resection for follicular thyroid neoplasm: a multicenter study

To compare thermal ablation (TA) and surgical resection (SR) for follicular thyroid neoplasm (FTN) with F-TIRADS score lower than 12 points in terms of overall, 1-, 3-, and 5-year progression-free survival rates and complication rates. In this retrospective study, 692 patients with FTN treated by TA or SR across 9 centers between January 2014 and June 2023 were included. The primary outcomes were overall and 1-, 3-, and 5-year progression-free survival rates and complication rates. As a result, 258 patients (median age: 43.5 years, 205 females) in the TA group and 135 patients (median age: 49 years, 101 females) in the SR group were followed for a median of 23 months and 25 months, respectively. TA resulted in shorter incision length, procedure durations and hospitalization (all p < 0.001). There was no evidence of differences in overall, 1-, 3-, or 5-year progression-free survival rates (all p > 0.05) between TA and SR (5-year: 98.6% vs. 99.4%, p = 0.31). Permanent hoarseness (8.1% [15/135], p < 0.001), permanent hypoparathyroidism (0.7% [1/135], p = 0.74), transient hypoparathyroidism (3.0% [4/135], p = 0.02) and the need for lifelong hormone replacement therapy (64.4% [87/135], p < 0.001) were encountered only in the SR group. There was no evidence of difference in progression-free survival rates between TA and SR for FTN with F-TIRADS score lower than 12 points, and TA resulted in fewer complications and no need of hormone replacement therapy. Therefore, TA is a feasible alternative for selected patients with FTN.