Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study

Medas F, Dobrinja C, Al-Suhaimi EA, Altmeier J, Anajar S, Arikan AE, Azaryan I, Bains L, Basili G, Bolukbasi H, Bononi M, Borumandi F, Bozan MB, Brenta G, Brunaud L, Brunner M, Buemi A, Canu GL, Cappellacci F, Cartwright SB, Castells Fusté I, Cavalheiro B, Cavallaro G, Chala A, Chan SYB, Chaplin J, Cheema MS, Chiapponi C, Chiofalo MG, Chrysos E, D'Amore A, de Cillia M, De Crea C, de Manzini N, de Matos LL, De Pasquale L, Del Rio P, Demarchi MS, Dhiwakar M, Donatini G, Dora JM, D'Orazi V, Doulatram Gamgaram VK, Eismontas V, Kabiri EH, El Malki HO, Elzahaby I, Enciu O, Eskander A, Feroci F, Figueroa-Bohorquez D, Filis D, François G, Frías-Fernández P, Gamboa-Dominguez A, Genc V, Giordano D, Gómez-Pedraza A, Graceffa G, Griffin J, Guerreiro SC, Gupta K, Gupta KK, Gurrado A, Hajiioannou J, Hakala T, Harahap WA, Hargitai L, Hartl D, Hellmann A, Hlozek J, Hoang VT, Iacobone M, Innaro N, Ioannidis O, Jang JH, Xavier-Junior JC, Jovanovic M, Kaderli RM, Kakamad F, Kaliszewski K, Karamanliev M, Katoh H, Košec A, Kovacevic B, Kowalski LP, Králik R, Yadav SK, Kumorová A, Lampridis S, Lasithiotakis K, Leclere JC, Leong EKF, Leow MKS, Lim JY, Lino-Silva LS, Liu SYW, Llorach NP, Lombardi CP, López-Gómez J, Lori E, Quintanilla-Dieck L, Lucchini R, Madani A, Manatakis D, Markovic I, Materazzi G, Mazeh H, Mercante G, Meyer-Rochow GY, Mihaljevic O, Miller JA, Minuto M, Monacelli M, Mulita F, Mullineris B, Muñoz-de-Nova JL, Muradás Girardi F, Nader S, Napadon T, Nastos C, Offi C, Ronen O, Oragano L, Orois A, Pan Y, Panagiotidis E, Panchangam RB, Papavramidis T, Parida PK, Paspala A, Pérez ÒV, Petrovic S, Raffaelli M, Ramacciotti CF, Ratia Gimenez T, Rivo Vázquez Á, Roh JL, Rossi L, Sanabria A, Santeerapharp A, Semenov A, Seneviratne S, Serdar A, Sheahan P, Sheppard SC, Slotcavage RL, Smaxwil C, Kim SY, Sorrenti S, Spartalis E, Sriphrapradang C, Testini M, Turk Y, Tzikos G, Vabalayte K, Vargas-Osorio K, Vázquez Rentería RS, Velázquez-Fernández D, Vithana SMP, Yücel L, Yulian ED, Zahradnikova P, Zarogoulidis P, Ziablitskaia E, Zolotoukho A, Calò PG (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Book Volume: 11

Pages Range: 402-413

Journal Issue: 6

DOI: 10.1016/S2213-8587(23)00094-3

Abstract

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 [78·6%] female patients and 4922 [21·4%] 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, 1·4 [IQR 0·6-3·4]) compared with the prepandemic phase (2·0 [0·9-3·7]; p<0·0001) and pandemic decrease phase (2·3 [1·0-5·0]; p<0·0001). Compared with the prepandemic phase, in the pandemic decrease phase we observed an increased occurrence of thyroid tumours larger than 10 mm (2554 [69·0%] of 3704 vs 1515 [71·5%] of 2119; OR 1·1 [95% CI 1·0-1·3]; p=0·042), lymph node metastases (343 [9·3%] vs 264 [12·5%]; OR 1·4 [1·2-1·7]; p=0·0001), and tumours at high risk of structural disease recurrence (203 [5·7%] of 3584 vs 155 [7·7%] of 2006; OR 1·4 [1·1-1·7]; p=0·0039). 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.None.

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Involved external institutions

Imam Abdulrahman Bin Faisal University Saudi Arabia (SA) National and Kapodistrian University of Athens Greece (GR) Sisters of Charity Hospital / Klinički Bolnički Centar Sestre Milosrdnice (KBCSM) Croatia (HR) Diakonie-Klinikum Stuttgart Diakonissenkrankenhaus und Paulinenhilfe Germany (DE) University of Indonesia (UI) / Universitas Indonesia Indonesia (ID) University of Toronto Canada (CA) University-Hospital Polyclinic of Modena / Azienda Ospedaliero-Universitaria di Modena Italy (IT) University of Padua / Universita degli Studi di Padova Italy (IT) University of Arkansas for Medical Sciences (UAMS) United States (USA) (US) Institute of Oncology and Radiology of Serbia / Institut za onkologiju i radiologiju Srbije Serbia (RS) Instituto Nacional de Cancerología Mexico (MX) Azienda Ospedaliero-Universitaria Pisana Italy (IT) All India Institute of Medical Sciences India (IN) CMH Lahore Medical College and Institute of Dentistry Pakistan (PK) The Ohio State University Wexner Medical Center (OSUMC) United States (USA) (US) Università degli Studi di Trieste Italy (IT) University of Colombo Sri Lanka (LK) Medanta India (IN) Comenius University Bratislava Slovakia (SK) Chulalongkorn University / จุฬาลงกรณ์มหาวิทยาลัย Thailand (TH) Mohammed V University (UMVA) / جامعة محمد الخامس‎ Morocco (MA) Ahvaz Jundishapur University of Medical Sciences (AJUMS) / دانشگاه علوم پزشکی جندی‌شاپور اهواز Iran, Islamic Republic of (IR) Cliniques universitaires Saint-Luc (CHU St-Luc) Belgium (BE) A.C.Camargo Cancer Center Brazil (BR) Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán Mexico (MX) First Affiliated Hospital of Jinan University / 暨南大学附属第一医院 China (CN) V.I. Vernadsky Crimean Federal University / Крымский федеральный университет имени В.И. Вернадского Ukraine (UA) Medizinische Universität Wien Austria (AT) Université de Lorraine France (FR) University Hospitals Birmingham NHS Foundation Trust United Kingdom (GB) Colombia National University Hospital / Hospital Universitario Nacional de Colombia Colombia (CO) Centre Hospitalier Universitaire Carémeau France (FR) Athens Naval & Veterans Hospital Greece (GR) Midland Regional Hospital at Tullamore / Ospidéal Ginearálta Thulach Mhór Ireland (IE) Hospital Privado Argentina (AR) Hospital Ana Nery Brazil (BR) Università degli studi "La Sapienza" Italy (IT) Instituto Mexicano del Seguro Social Mexico (MX) Hospital de Clínicas de Porto Alegre (HCPA) Brazil (BR) Hospital Universitario Príncipe de Asturias Spain (ES) Kovai Medical Center and Hospital (KMCH) India (IN) Saint Petersburg State Medical University Russia Russian Federation (RU) Hospital César Milstein Argentina (AR) Aristotle University of Thessaloniki Greece (GR) Thien Hanh Hospital / Bệnh viện Đa khoa Thiện Hạnh Viet Nam (VN) University of Kragujevac Serbia (RS) Univerzita Karlova v Praze / Charles University in Prague Czech Republic (CZ) Azienda Ospedaliero Universitario Mater Domini Italy (IT) Kandy Teaching Hospital Sri Lanka (LK) Institut Gustave-Roussy France (FR) Surgery Bitenc / Kirurgija Bitenc Slovenia (SI) University of Parma / Università degli Studi di Parma Italy (IT) Hospital Universitario de La Princesa Spain (ES) Ospedale del Mare Italy (IT) Central military hospital / Ústredná Vojenská Nemocnica Ružomberok (UVN) Slovakia (SK) South Infirmary Victoria University Hospital Ireland (IE) Humanitas University Italy (IT) Complejo Hospitalario Universitario de Santiago de Compostela Spain (ES) Medical University Pleven / Медицински университет - Плевен Bulgaria (BG) Universitat de Barcelona (UB) / University of Barcelona Spain (ES) Università degli studi di Milano Italy (IT) Fondazione Policlinico Universitario Agostino Gemelli IRCCS Italy (IT) 424 General Military Hospital Greece (GR) Klaipėdos Universitetas Lithuania (LT) Università degli Studi di Cagliari Italy (IT) Universitätsklinikum Köln Germany (DE) Policlinico Umberto I Italy (IT) Patras General Hospital Agios Andreas Greece (GR) Universitas Andalas Indonesia (ID) Clinical Center of Serbia Serbia (RS) Wrocław Medical University / Uniwersytet Medyczny we Wrocławiu Poland (PL) Azienda Usl Toscana Nord Ovest Italy (IT) Ramathibodi Hospital / โรงพยาบาลรามาธิบดี Thailand (TH) Medical University Gdansk / Gdański Uniwersytet Medyczny Poland (PL) Srinakharinwirot University / มหาวิทยาลัยศรีนครินทรวิโรฒ Thailand (TH) Hospital Parc Tauli Spain (ES) Hospital Universitario Mútua Terrassa Spain (ES) Maulana Azad Medical College (MAMC) India (IN) The Chinese University of Hong Kong (CUHK) China (CN) Università degli Studi di Perugia Italy (IT) Waikato Hospital New Zealand (NZ) Ajou University Korea, Republic of (KR) Netaji Subhash Chandra Bose Medical College (NSCB Medical College) India (IN) Universidad de Caldas / Caldas University Colombia (CO) Smart Health Tower Iraq (IQ) University of Health Sciences Vientiane / ມະຫາວິທະຍາໄລ ວິທະຍາສາດ ສຸຂະພາບ Lao People's Democratic Republic (LA) Military Medical Academy (Serbia) / Војномедицинска академија / Vojnomedicinska akademija (VMA) Serbia (RS) University General Hospital of Heraklion Greece (GR) Mansoura University / جامعة المنصورة Egypt (EG) Università degli Studi di Palermo Italy (IT) Military Hospital Mohammed V Morocco (MA) Epworth Healthcare Australia (AU) St Richard's Hospital United Kingdom (GB) Ospedale S. Maria della Misericordia / Azienda Ospedaliera di Perugia Italy (IT) Bar-Ilan University Israel (IL) University of Nebraska Medical Center (UNMC) United States (USA) (US) Tampere University Hospital / Tampereen yliopistollinen sairaala (TAYS) Finland (FI) Singapore General Hospital Singapore (SG) Istituto Nazionale Tumori IRCCS "Fondazione G. Pascale" Italy (IT) Inselspital, Universitätsspital Bern Switzerland (CH) Geneva University Hospitals / Hôpitaux universitaires de Genève (HUG) Switzerland (CH) Hospital Asil de Granollers Spain (ES) Tseung Kwan O Hospital / 將軍澳醫院 China (CN) Tan Tock Seng Hospital Singapore (SG) Hospital Regional de Málaga Spain (ES) Centre hospitalier universitaire de Brest (CHRU Brest) France (FR) Hospital Curry Cabral Portugal (PT) Theageneio Hospital of Thessaloniki / Theagenio Cancer Hospital of Thessaloniki / Θεαγένειο Αντικαρκινικό Νοσοκομείο Θεσσαλονίκης Greece (GR) CHA University / 차의과학대학교 Korea, Republic of (KR) University of Bari Aldo Moro / Università degli Studi di Bari Aldo Moro Italy (IT) Attikon Hospital / Πανεπιστημιακού Γενικού Νοσοκομείου "Αττικόν" Greece (GR) Auckland City Hospital New Zealand (NZ) National University Hospital (NUH) Singapore (SG) Complejo Hospitalario Universitario de Vigo (CHUVI) Spain (ES) University of Genova / Università degli Studi di Genova Italy (IT) Universidad de Antioquía (UDEA) Colombia (CO) General University Hospital of Larissa Greece (GR) University of São Paulo / Universidade de São Paulo (USP) Brazil (BR) Acıbadem Mehmet Ali Aydınlar University / Acıbadem Mehmet Ali Aydınlar Üniversitesi Turkey (TR) Centre hospitalier universitaire de Poitiers (CHU de Poitiers) France (FR) Instituto de Patologia de Araçatuba Brazil (BR) Oregon Health and Science University (OSHU) United States (USA) (US) Mohammed VI University of Health and Medical Sciences (UM6SS) / Université Mohammed VI des Sciences de la Santé Morocco (MA) Ege University / Ege Üniversitesi Turkey (TR) Ospedale San Biagio Italy (IT) Hadassah Medical Center / מרכז רפואי הדסה‎‎ Israel (IL) Ankara University / Ankara Üniversitesi Turkey (TR) Hospital Médica Sur Mexico (MX) Lausanne University Hospital / Centre hospitalier universitaire vaudois (CHUV) Switzerland (CH) Kitasato University Hospital / 北里大学病院 Japan (JP) Bhargav Endocrine Hospital India (IN) Carol Davila University of Medicine and Pharmacy / Universitatea de Medicină și Farmacie „Carol Davila” (UMF București) Romania (RO)

How to cite

APA:

Medas, F., Dobrinja, C., Al-Suhaimi, E.A., Altmeier, J., Anajar, S., Arikan, A.E.,... Calò, P.G. (2023). Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study. Lancet Diabetes and Endocrinology, 11(6), 402-413. https://dx.doi.org/10.1016/S2213-8587(23)00094-3

MLA:

Medas, Fabio, et al. "Effect of the COVID-19 pandemic on surgery for indeterminate thyroid nodules (THYCOVID): a retrospective, international, multicentre, cross-sectional study." Lancet Diabetes and Endocrinology 11.6 (2023): 402-413.

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