Abstract
Background: The extent of surgery for differentiated thyroid cancer (DTC) remains a controversial issue. Since a less aggressive approach is becoming more predominant, we aim here to study the short- and long-term outcomes of DTC patients after hemithyroidectomy. Methods: From a total of 1252 consecutive papillary thyroid cancer (PTC) patients, 109 treated with hemithyroidectomy and 50 with total thyroidectomy but no I131 were included. Persistent or recurrent disease was defined based on histopathology, imaging studies, and thyroglobulin levels. Results: Our hemithyroidectomy cohort included females (84.4%), microcarcinomas (81.9%), TNM stage I (95.4%), and a low American Thyroid Association (ATA) recurrence risk (94.5%). At one-year post-treatment, 3.7% had persistent disease (all female, median age 55 years, tumor size 7.5 mm). Recurrent disease was detected in 7.5% of those with excellent response at 1-year. With a follow-up of 8.6 years (1–48), all 109 patients were disease free at last visit, including the 11 patients (10.1%) who received additional treatment. Also, when comparing the hemi- and total thyroidectomy groups no significant differences were found in the rate of persistent and recurrent disease, overall mortality, and disease status at last visit. Conclusions: For properly selected low-risk PTC patients, hemithyroidectomy is a safe treatment option with a favorable long-term outcome.
Highlights
Thyroid cancer is the most prevalent endocrine malignancy worldwide, with an incidence that has nearly tripled over the last two decades [1,2]
From a total of 1252 consecutive papillary thyroid cancer patients treated at the Assaf Harofeh and Rabin Medical Centers, 159 surgically treated patients with a similar TNM stage (109 patients treated with hemithyroidectomy and 50 with total thyroidectomy and no radioactive iodine (RAI)) were considered for this analysis
93.5% had no extrathyroidal extension (ETE), and 99.1% had no clinical evidence of lymph node metastases (LNM)
Summary
Thyroid cancer is the most prevalent endocrine malignancy worldwide, with an incidence that has nearly tripled over the last two decades [1,2]. Despite a relatively low mortality rate, disease recurrence/persistence can reach up to 30% [4]. Data on the long-term outcome of patients with well-differentiated thyroid carcinoma (DTC) shows a low rate of disease-specific mortality (DSM), which has been reported in the range of 2–5% when all stages are considered [4]. A less aggressive approach has evolved in recent decades, including the option of hemithyroidectomy for tumors up to 4 cm, and even active surveillance for microscopic. Since a less aggressive approach is becoming more predominant, we aim here to study the short- and long-term outcomes of DTC patients after hemithyroidectomy. Methods: From a total of 1252 consecutive papillary thyroid cancer (PTC) patients, 109 treated with hemithyroidectomy and 50 with total thyroidectomy but no I131 were included.
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