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      Lobectomy Is Feasible for 1–4 cm Papillary Thyroid Carcinomas: A 10-Year Propensity Score Matched-Pair Analysis on Recurrence

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          Abstract

          Current guidelines allow lobectomy as treatment for 1-4 cm papillary thyroid carcinomas (PTCs), as previous studies reported no clear survival advantages for total thyroidectomy (TT). However, data on recurrence based on surgical extent are limited.

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          Thyroid lobectomy for treatment of well differentiated intrathyroid malignancy.

          Iain Nixon, Ian Ganly, Snehal Patel … (2012)
          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. 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. 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). Patients with pT1T2 N0 WDTC can be safely managed by thyroid lobectomy alone. Copyright © 2012 Mosby, Inc. All rights reserved.
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            Surgery for papillary thyroid carcinoma: is lobectomy enough?

            Maie A R St John, Abie Mendelsohn, Elliot Abemayor … (2010)
            To further understanding of treatment of papillary thyroid carcinoma (PTC). The Surveillance, Epidemiology, and End Results Program database was searched for patients who had undergone surgery for PTC. Areas covered by Surveillance, Epidemiology, and End Results population-based registries. Patients who had undergone PTC surgery between January 1, 1988, and December 31, 2001, were included in the study. Disease-specific survival (DSS) and overall survival (OS). Of the total 22,724 patients with PTC, 5964 patients underwent lobectomy. There were 2138 total and 471 disease-specific deaths. Controlling for tumor size, multivariate analysis revealed no survival difference between patients who had undergone total thyroidectomy and those who had undergone lobectomy. Increased tumor size, extrathyroidal extent, positive nodal status, and increased age displayed significantly worse DSS and OS (P < .001). Histologically, follicular PTC subtype did not affect DSS or OS. Patients who had received radioactive iodine had poorer DSS but improved OS. Patients undergoing external beam radiation therapy had poor DSS (hazard ratio, 4.48; 95% confidence interval, 3.30-6.06; P < .001) and OS (1.71; 1.42-2.07; P < .001). The results of this study compel us to reinvestigate the current PTC surgical recommendations of total thyroidectomy based on tumor size because this may not affect survival across all populations. In addition, the current use of external beam radiation therapy for the treatment of PTC should be reexamined.
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              Overall and cause-specific survival for patients undergoing lobectomy, near-total, or total thyroidectomy for differentiated thyroid cancer.

              Brett Barney, Dennis C. Shrieve, Jonathan D. Tward … (2011)
              The extent of surgery for well-differentiated thyroid cancer remains controversial. The purpose of this study was to evaluate the type of resection, age, T classification, nodal status, tumor size, and year of diagnosis for overall survival (OS) and cause-specific survival (CSS) using a large database. Using the Surveillance, Epidemiology, and End Results (SEER) database, 23,605 subjects were identified with papillary or follicular thyroid cancer between 1983 and 2002. OS and CSS were estimated, and outcomes for local excision, lobectomy, near-total thyroidectomy, or total thyroidectomy were compared. Ten-year OS and CSS by surgery were: total thyroidectomy, 90.4% and 96.8%, respectively; near-total thyroidectomy, 89.5% and 96.6%, respectively; and lobectomy, 90.8% and 98.6%, respectively. Controlling for risk factors, near-total thyroidectomy was inferior to total thyroidectomy for OS (hazard ratio [HR] 1.21; p = .019) and CSS (HR 1.39; p = .019). Age, T3/T4 disease, positive nodes, and tumor size were associated with poorer outcomes. Total thyroidectomy resulted in improved survival. Therapy should be individualized, accounting for potential complications and recurrence patterns. Copyright © 2010 Wiley Periodicals, Inc.
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                Author and article information

                Journal
                Title: Thyroid
                Abbreviated Title: Thyroid
                Publisher: Mary Ann Liebert Inc
                ISSN (Print): 1050-7256
                ISSN (Electronic): 1557-9077
                Publication date Created: January 2019
                Publication date (Print): January 2019
                Volume: 29
                Issue: 1
                Pages: 64-70
                Affiliations
                [1 ]Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
                [2 ]Department of Clinical Epidemiology and Biostatistics, and Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
                [3 ]Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
                Article
                DOI: 10.1089/thy.2018.0554
                PubMed ID: 30375260
                SO-VID: a4b079ed-74be-4181-a3c1-51517b859564
                Copyright © © 2019
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