BACKGROUND: thyroid cancer is the most commn endocrine cancer and its incidence is increasing wordwide; despite this rising incidence, mortality rates have continued to decline. The extent of thyroid resection for well-differentiated low risk thyroid cancers is still controversial; the most recent Guidelines by the American Thyroid Association suggest that, for patients with papillary carcinoma smaller than 4 cm, without extra-thyroid extension and without clinically positive lymph nodes, the initial treatment can be either a bilateral procedure or a thyroid lobectomy, since the low risk of long-term recurrence and the excellent prognosis of these tumors. The primary aim of this study is to evalute the extent of disease, both in the thyroid and lymph nodes, in patients undergoing total thyroidectomy +/- prophylactic central neck dissection for a single thyroid nodule with indeterminate or malignant cytology. Secondary objective is to verify whether a less aggressive surgical approach can allow adequate oncological radicality with less morbidity. MATERIALS AND METHODS: we retrospectly analyzed the data of patients undergoing total thyroidectomy +/- prophylactic central neck dissection for a single thyroid nodule with indeterminate cytology and BRAF mutation, or for intrathyroid unifocal cT1T2cN0 papillary thyroid carcinoma who were treated in our Department from Jenuary 2012 to December 2019. RESULTS: patients included in the study were 83 (mean age 48.7 years, median 49 years) of wich 62 women (74.7%, mean age 49.4 years, median 49 years) and 21 men (25.3%, mean age 46.6 years, median 49 years). Histologically 82 patients were affected by papillary carcinoma and 1 by follicular carcinoma (mean size 14.2 mm, range 1-40 mm). Fifty patients (60.2%, 39 women and 11 men) were N0, and thirty three (39.8%, 23 women and 10 men) were N1. Regarding the numebr of positive lymph nodes, 28 patients had a number of involved lymph nodes ≤ 5, while in 5 patients the number of positive lymph nodes was ≥ 6. Among N0 patients, 45 patients had a carcinoma smaller than 20 mm and in 5 patients the carcinoma was between 21-40 mm. When considering TNM classification, 40 patients were pT1, 4 patients pT2 and 6 patients pT3. Finally, in this group of patients 14 had bilateral disease. Among N1 patients, 25 had a carcinoma smaller than 20 mm and in 8 patients the carcinoma was between 21 and 40 mm. Twenty-two patients were pT1, 9 patients pT2 and 2 patients pT3. In 6 of these patients the disease was bilateral. If these patients had undergone lobectomy alone, 47 patients (56.6%) would have had residual disease; if the patients had undergone lobectomy and ipsilateral prophylactic central neck dissection, contralateral disease would have remained in 20 patients (24.1%), represented in all cases by microcarcinomas. CONCLUSIONS: for patients with papillary thyroid carcinoma smaller than 4 centimeters, without extra-thyroid extension and without clinically positive lymph nodes, lobectomy associated with ipsilateral prophylactic central neck dissection can be considered a valid therapeutic option both from the point of view of oncological outcome and post-operative morbidity.
Estensione della chirurgia nei carcinomi differenziati della tiroide a basso rischio: analisi retrospettiva della casistica di un Centro di Riferimento
REINA, SIMONA
2024-05-28
Abstract
BACKGROUND: thyroid cancer is the most commn endocrine cancer and its incidence is increasing wordwide; despite this rising incidence, mortality rates have continued to decline. The extent of thyroid resection for well-differentiated low risk thyroid cancers is still controversial; the most recent Guidelines by the American Thyroid Association suggest that, for patients with papillary carcinoma smaller than 4 cm, without extra-thyroid extension and without clinically positive lymph nodes, the initial treatment can be either a bilateral procedure or a thyroid lobectomy, since the low risk of long-term recurrence and the excellent prognosis of these tumors. The primary aim of this study is to evalute the extent of disease, both in the thyroid and lymph nodes, in patients undergoing total thyroidectomy +/- prophylactic central neck dissection for a single thyroid nodule with indeterminate or malignant cytology. Secondary objective is to verify whether a less aggressive surgical approach can allow adequate oncological radicality with less morbidity. MATERIALS AND METHODS: we retrospectly analyzed the data of patients undergoing total thyroidectomy +/- prophylactic central neck dissection for a single thyroid nodule with indeterminate cytology and BRAF mutation, or for intrathyroid unifocal cT1T2cN0 papillary thyroid carcinoma who were treated in our Department from Jenuary 2012 to December 2019. RESULTS: patients included in the study were 83 (mean age 48.7 years, median 49 years) of wich 62 women (74.7%, mean age 49.4 years, median 49 years) and 21 men (25.3%, mean age 46.6 years, median 49 years). Histologically 82 patients were affected by papillary carcinoma and 1 by follicular carcinoma (mean size 14.2 mm, range 1-40 mm). Fifty patients (60.2%, 39 women and 11 men) were N0, and thirty three (39.8%, 23 women and 10 men) were N1. Regarding the numebr of positive lymph nodes, 28 patients had a number of involved lymph nodes ≤ 5, while in 5 patients the number of positive lymph nodes was ≥ 6. Among N0 patients, 45 patients had a carcinoma smaller than 20 mm and in 5 patients the carcinoma was between 21-40 mm. When considering TNM classification, 40 patients were pT1, 4 patients pT2 and 6 patients pT3. Finally, in this group of patients 14 had bilateral disease. Among N1 patients, 25 had a carcinoma smaller than 20 mm and in 8 patients the carcinoma was between 21 and 40 mm. Twenty-two patients were pT1, 9 patients pT2 and 2 patients pT3. In 6 of these patients the disease was bilateral. If these patients had undergone lobectomy alone, 47 patients (56.6%) would have had residual disease; if the patients had undergone lobectomy and ipsilateral prophylactic central neck dissection, contralateral disease would have remained in 20 patients (24.1%), represented in all cases by microcarcinomas. CONCLUSIONS: for patients with papillary thyroid carcinoma smaller than 4 centimeters, without extra-thyroid extension and without clinically positive lymph nodes, lobectomy associated with ipsilateral prophylactic central neck dissection can be considered a valid therapeutic option both from the point of view of oncological outcome and post-operative morbidity.
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