Total versus hemithyroidectomy for microscopic papillary thyroid cancer.

Abstract

BACKGROUND:

No increased mortality has been reported in patients with thyroid papillary microcarcinoma (PMC); however, neck recurrences and distant metastases have been described. In this study, we compare patients' outcomes after total thyroidectomy vs hemithyroidectomy for treatment of thyroid PMC.

METHODS:

Two hundred and ninety-three patients from two major medical centers in Israel were included. The mean follow-up period was 7.2±6.8 yr.

RESULTS:

Total thyroidectomy was performed in 214 patients and hemithyroidectomy in 79 patients. Mean tumor size was 6.3±3 mm. Lymph-node (LN) metastases and extraglandular extension were more frequent in the total thyroidectomy group than in the hemithyroidectomy group, 24.8% vs 1.3% (p<0.001) and 11.7% vs 3.8% (p=0.042), respectively. The cumulative incidence of recurrence at the end of follow-up was 13.2% in the total thyroidectomy group and 14.3% in the hemithyroidectomy group (p=ns). The incidence of recurrence was higher in patients with LN involvement in both groups. Considering low risk patients only (monofocal tumors, no LN involvement, no extraglandular extension; no.=63 in the total thyroidectomy group vs no.=60 in the hemithyroidectomy group) neck recurrence was found in 10% of patients in the hemithyroidectomy group but none in the total thyroidectomy group. In the hemithyroidectomy group, all locoregional recurrences were diagnosed using ultrasonography, compared to 47.6% in the total thyroidectomy group.

CONCLUSION:

For patients with monofocal disease within the thyroid gland and no LN involvement, hemithyroidectomy can be considered an option, bearing in mind a higher risk for recurrence. For all other patients with PMC, we propose total thyroidectomy as initial treatment.

• Authors: M Gershinsky, O Barnett-Griness, N Stein, D Hirsch, G Tzvetov, O Bardicef, J Pauker, S Grozinsky-Glasberg, S Ish-Shalom, I Slutski, I Shimon, C Benbassat
• Journal: Journal of endocrinological investigation (J Endocrinol Invest) Vol. 35 Issue 5 Pg. 464-8 (May 2012) ISSN: 1720-8386 [Electronic] Italy
• PMID: 21952495 (Publication Type: Comparative Study, Journal Article)

Topics

• Adenocarcinoma, Papillary (diagnosis, surgery)
• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Female
• Follow-Up Studies
• Humans
• Israel
• Male
• Middle Aged
• Neoplasm Metastasis
• Neoplasm Recurrence, Local (diagnosis, surgery)
• Prognosis
• Prospective Studies
• Thyroid Neoplasms (diagnosis, surgery)
• Thyroidectomy
• Young Adult