scholarly journals Impact of Extent of Surgery on Survival for Papillary Thyroid Cancer Patients Younger Than 45 Years

2015 ◽  
Vol 100 (1) ◽  
pp. 115-121 ◽  
Author(s):  
Mohamed Abdelgadir Adam ◽  
John Pura ◽  
Paolo Goffredo ◽  
Michaela A. Dinan ◽  
Terry Hyslop ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Papillary Thyroid Cancer ◽  
Extent Of Resection ◽  
Stage I ◽  
Papillary Thyroid ◽  
Cancer Data ◽  
Thyroid Lobectomy ◽  
Extent Of Surgery ◽  
The Impact

Abstract Context: Papillary thyroid cancer (PTC) patients <45 years old are considered to have an excellent prognosis; however, current guidelines recommend total thyroidectomy for PTC tumors >1.0 cm, regardless of age. Objective: Our objective was to examine the impact of extent of surgery on overall survival (OS) in patients <45 years old with stage I PTC of 1.1 to 4.0 cm. Design, Setting, and Patients: Adult patients <45 years of age undergoing surgery for stage I PTC were identified from the National Cancer Data Base (NCDB, 1998–2006) and the Surveillance, Epidemiology, and End Results dataset (SEER, 1988–2006). Main Outcome Measure: Multivariable modeling was used to compare OS for patients undergoing total thyroidectomy vs lobectomy. Results: In total, 29 522 patients in NCDB (3151 lobectomy, 26 371 total thyroidectomy) and 13 510 in SEER (1379 lobectomy, 12 131 total thyroidectomy) were included. Compared with patients undergoing lobectomy, patients having total thyroidectomy more often had extrathyroidal and lymph node disease. At 14 years, unadjusted OS was equivalent between total thyroidectomy and lobectomy in both databases. After adjustment, OS was similar for total thyroidectomy compared with lobectomy across all patients with tumors of 1.1 to 4.0 cm (NCDB: hazard ratio = 1.45 [confidence interval = 0.88–2.51], P = 0.19; SEER: 0.95 (0.70–1.29), P = 0.75) and when stratified by tumor size: 1.1 to 2.0 cm (NCDB: 1.12 [0.50–2.51], P = 0.78; SEER: 0.95 [0.56–1.62], P = 0.86) and 2.1 to 4.0 cm (NCDB: 1.93 [0.88–4.23], P = 0.10; SEER: 0.94 [0.60–1.49], P = 0.80). Conclusions: After adjusting for patient and clinical characteristics, total thyroidectomy compared with thyroid lobectomy was not associated with improved survival for patients <45 years of age with stage I PTC of 1.1 to 4.0 cm. Additional clinical and pathologic factors should be considered when choosing extent of resection.

scholarly journals Prognostic Factors in Mortality and Morbidity in Patients with differentiated Thyroid Cancer

2002 ◽  
Vol 81 (12) ◽  
pp. 856-863 ◽  
Author(s):  
Robert L. Witt ◽  
Ann Marie McNamara
Keyword(s):  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Papillary Thyroid Cancer ◽  
Tumor Size ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Papillary Thyroid ◽  
Nerve Paralysis ◽  
Mortality And Morbidity ◽  
Risk Of Death ◽  
Thyroid Lobectomy

We attempted to determine if women younger than 45 years of age who have isolated papillary thyroid cancer and whose tumors are smaller than 4 cm (T2N0M0) are at low risk for mortality and morbidity following thyroid lobectomy. To this end, we analyzed information on both women and men obtained from our review of the literature, and we integrated it with data compiled in the Delaware Cancer Registry. We performed a secondary analysis to determine if the risk of death and recurrence can be predicted on the basis of age, tumor size, sex, histology, and the type of operation. We found that among patients who had undergone either thyroid lobectomy or total thyroidectomy, mortality rates were 1.3% for those younger than 45 years of age and 15.6% for those 45 years and older (p< 0.0001). With respect to tumor size, patients whose masses were smaller than 4 cm had significantly lower mortality (3.0%) and recurrence (11.1%) rates than did those whose tumors were 4 cm or larger (16.8 and 33.3%, respectively; p< 0.0001). Other significant risk factors for death were male sex and the presence of follicular thyroid cancer (as opposed to papillary thyroid cancer). The risk of permanent hypocalcemia was significant among patients who had undergone total thyroidectomy, but not among those who had been treated with lobectomy. The subgroup of patients who had the lowest risk of mortality and morbidity was made up of women younger than 45 years who had a papillary thyroid tumor smaller than 4 cm that was limited to one lobe and who had undergone lobectomy. On the other hand, we found that lobectomy might carry a higher risk of recurrence (from a micrometastasis in the cervical lymph node) than does total thyroidectomy. Experienced surgeons whose rates of hypocalcemia and recurrent laryngeal nerve paralysis following total thyroidectomy are low offer their patients the unambiguous advantage of superior follow-up with thyroglobulin and radioactive iodine.

Changes in total thyroidectomy versus thyroid lobectomy for papillary thyroid cancer during the past 15 years

Surgery ◽  
2019 ◽  
Vol 166 (1) ◽  
pp. 41-47 ◽  
Author(s):  
Benjamin C. James ◽  
Lava Timsina ◽  
Ryan Graham ◽  
Peter Angelos ◽  
David A. Haggstrom
Keyword(s):  
Thyroid Cancer ◽  
Total Thyroidectomy ◽  
Papillary Thyroid Cancer ◽  
Papillary Thyroid ◽  
The Past ◽  
Thyroid Lobectomy
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