Incidence of Recurrent Differentiated Thyroid Carcinoma in Paediatrics and Adolescents after Thyroid Surgery: A Meta-Analysis Study of Last 20 Years

Abstract Background: Childhood onset differentiated thyroid cancer is distinct from the adult-onset disease being more aggressive at the time of initial evaluation with a higher risk category for disease recurrence; however, it is ultimately less lethal. Unfortunately, there is no consensus regarding the means of follow-up, timing and management strategy regarding pediatric differentiated thyroid cancer. For these reasons, unique man-agement for children and adolescents with thyroid tumors are needed. Aim of Study: To locate relevant studies comparing incidence of recurrent differentiated thyroid carcinoma in paediatrics and adolescents after thyroid surgery modalities most commonly used in childhood onset differentiated thyroid cancer that are published in the period from June 1999 to June 2019, revising all these studies, and designing meta-analysis study to assess the overall results and define which management may provide better outcome and fewer rate of complications. Patients and Methods: The search strategy above will be viewed,and articles that appear to fulfil the inclusion criteria will be retrieved in full. Each article identified will be reviewed and categorized into one of the following groups: Included or excluded. When there will be a doubt, a second reviewer will assess the article and a consensus will be reached. Results: Medline databases (PubMed, Medscape, Science Direct. EMF-Portal) and all materials available in the Internet till 2019. Conclusion: All children will require life-long surveillance after thyroid surgery, especially for thyroid cancer. Paediatric thyroid cancer is rare. (The incidence of differentiated thyroid cancer is 1 per 1,000,000 in children less than 10 years of age). It is a treatable disease with an excellent prognosis. Treatment with radioactive iodine is recommended for most children after total thyroidectomy for papillary and follicular cancer. Radioiodine ablation should be carried about 4 weeks after surgery, with a diagnostic scan 6 months later. Regular review should include neck palpation, serum thyroglobulin, and ultrasound with cytology if necessary. In case of a cancer, follow-up ultrasound and TSH-suppressed thyroglobulin (Tg) level assessment is performed 6 months after initial therapy and at least annually thereafter, although it may be preferable to observe patients every 6 months for at least 5 years after diagnosis of more advanced initial or metastatic cancer. Assessment of free T4, T3, and TSH levels is indicated every 6 months, and 1-2 months after dosage changes. Calcitonin is a marker of recurrent disease in medullary cancer. This suggests that an aggressive operative approach to lymph node resection may be safer (lower recurrence, lower complications) in experienced hands than a less complete resection in a lower volume center.