Abstract
Simple SummaryThe necessity of completion total thyroidectomy is unclear in patients with papillary thyroid microcarcinoma (PTMC) with only pathological central lymph node metastasis (pCLNM). The aim of our study was to determine the necessity of completion total thyroidectomy after an initial surgery by comparing the prognosis according to the presence of pCLNM during a long-term follow-up. We retrospectively compared the pathological central lymph node (pCLN)-positive group of 165 patients who underwent thyroid lobectomy with the pCLN-negative group of 711 patients and found no difference between the two groups in the recurrence rate and disease-free survival rates. Therefore, PTMC patients who underwent thyroid lobectomy with prophylactic central compartment neck dissection and were diagnosed with pCLNM after surgery do not require completion total thyroidectomy.The necessity of completion total thyroidectomy in patients with papillary thyroid microcarcinoma (PTMC) and pathological central lymph node metastasis (pCLNM) who underwent thyroid lobectomy with central compartment neck dissection (CCND) is unclear. We determined the necessity of completion total thyroidectomy by retrospectively comparing the prognosis according to the presence of pCLNM during a long-term follow-up. We enrolled 876 patients with PTMC who underwent thyroid lobectomy with prophylactic CCND from January 1986 to December 2009. Patients were divided according to central lymph node (CLN) metastasis: 165 (18.8%) and 711 (81.2%) in the CLN-positive and CLN-negative groups, respectively. Medical records were reviewed retrospectively, and clinicopathologic characteristics and recurrence rates were analyzed. The CLN-positive group was associated with male sex (p = 0.001), larger tumor size (p < 0.001), and more microscopic capsular invasion (p < 0.001) compared with the CLN-negative group. There was no significant difference between the two groups’ recurrence (p = 0.133) or disease-free (p = 0.065) survival rates. Univariate and multivariate analyses showed no factors associated with tumor recurrence except male sex (hazard ratio = 3.043, confidence interval 1.117–8.288, p = 0.030). Patients who were diagnosed with pCLNM after undergoing thyroid lobectomy with prophylactic CCND do not require completion total thyroidectomy; however, frequent follow-up is necessary for patients with PTMC and pCLNM.
Highlights
Thyroid cancer (TC) is an increasingly common malignancy, of which papillary thyroid cancer (PTC)is the most common histologic type, with a reported incidence of 80% to 85% [1,2]
Metastasis have a risk of recurrence, the effectiveness of completion total thyroidectomy in patients diagnosed with pathological Central lymph node (CLN) metastasis after surgery is still controversial
According to the 2015 American Thyroid Association (ATA) guidelines, completion total thyroidectomy is necessary in cases of unclear diagnosis after lobectomy, to provide complete resection of multicentric disease, and to allow for efficient radioactive iodine (RAI) therapy; the guidelines do not specify pathological CLN metastasis (pCLNM) [15]
Summary
Thyroid cancer (TC) is an increasingly common malignancy, of which papillary thyroid cancer (PTC)is the most common histologic type, with a reported incidence of 80% to 85% [1,2]. Central lymph node (CLN) metastasis has been reported in 20.7–62% of clinically lymph node negative (cN0) PTMC cases [6,7,8,9,10]. Previous studies reported that CLN metastasis was associated with recurrence [11,12,13,14]. Patients with CLN metastasis have a risk of recurrence, the effectiveness of completion total thyroidectomy in patients diagnosed with pathological CLN metastasis (pCLNM) after surgery is still controversial. According to the 2015 American Thyroid Association (ATA) guidelines, completion total thyroidectomy is necessary in cases of unclear diagnosis after lobectomy, to provide complete resection of multicentric disease, and to allow for efficient radioactive iodine (RAI) therapy; the guidelines do not specify pCLNM [15]
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