Elsevier

Surgery

Volume 151, Issue 4, April 2012, Pages 571-579
Surgery

Original Communication
Thyroid lobectomy for treatment of well differentiated intrathyroid malignancy

https://doi.org/10.1016/j.surg.2011.08.016Get rights and content

Background

There remains controversy over the type of surgery appropriate for T1T2N0 well differentiated thyroid cancers (WDTC). Current guidelines recommend total thyroidectomy for all but the smallest lesions, despite previous evidence from large institutions suggesting that lobectomy provides similar excellent results. The objective of this study was to report our experience of T1T2N0 WDTC managed by either thyroid lobectomy or total thyroidectomy.

Methods

Eight hundred eighty-nine patients with pT1T2 intrathyroid cancers treated surgically between 1986 and 2005 were identified from a database of 1810 patients with WDTC. Total thyroidectomy was carried out in 528 (59%) and thyroid lobectomy in 361 (41%) patients. Overall survival (OS), disease-specific survival (DSS) and recurrence-free survival (RFS) were determined by the Kaplan-Meier method. Factors predictive of outcome by univariate and multivariate analysis were determined using the log rank test and Cox proportional hazards method respectively.

Results

With a median follow-up of 99 months, the 10-yr OS, DSS, and RFS for all patients were 92%, 99%, and 98% respectively. Univariate analysis showed no significant difference in OS by extent of surgical resection. Multivariate analysis showed that age over 45 yr and male gender were independent predictors for poorer OS, whereas T stage and type of surgery were not. Comparison of the thyroid lobectomy group and the total thyroidectomy group showed no difference in local recurrence (0% for both) or regional recurrence (0% vs 0.8%, P = .96).

Conclusion

Patients with pT1T2 N0 WDTC can be safely managed by thyroid lobectomy alone.

Section snippets

Methods

Following approval by the Institutional Review Board, 889 patients (49%) who had thyroid surgery for T1T2 N0 cancer (using the 2009 AJCC staging manual11; T1: <2 cm, T2: 2–4 cm) between 1986 and 2005, were identified from our institutional database of 1810 patients treated for WDTC at MSKCC. Patients who underwent initial treatment elsewhere prior to referral or those who were considered unresectable at the time of referral were excluded.

Data collected included patient demographics, surgical

Entire group

The male to female ratio was about 2:7 (188 men and 701 women). The median age was 46 years (range, 4–91). Eight hundred patients (90%) had papillary carcinoma, 52 patients (6%) had follicular carcinoma, and 37 (4%) had Hürthle cell carcinoma. Nineteen patients were classified as having tall cell variant of papillary carcinoma. Although tall cell variant does have a slightly poorer outcome,12 we still consider this in the WDTC category.

Patient, tumor, and treatment details are shown in Table I.

Discussion

The surgical management of WDTC is based upon reports from retrospective data from both single institutional datasets and national cancer registries. It is well recognized that prospective, randomized controlled trials of therapy for thyroid cancer are impractical. The excellent survival outcome of patients would require large sample sizes and long follow-up to detect the small therapeutic advantages.14

Management of WDTC confined to the gland (T1T2) forms a significant part of surgical thyroid

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