Total thyroidectomy versus lobectomy in conventional papillary thyroid microcarcinoma: Analysis of 8,676 patients at a single institution Seo Ki Kim, MD,a Inhye Park, MD,a Jung-Woo Woo, MD,b Jun Ho Lee, MD,c Jun-Ho Choe, MD, PhD,a Jung-Han Kim, MD, PhD,a and Jee Soo Kim, MD, PhD,a Seoul and Changwon, South Korea
Background. Because there is a controversy regarding the management of papillary thyroid microcarcinoma, the purpose of this study was to compare lobectomy with total thyroidectomy as a primary operative treatment for papillary thyroid microcarcinoma. Loco-regional recurrence in the contralateral remnant lobe can be managed safely by completion thyroidectomy via the previous scar. However, reoperation for operation bed (thyroidectomy site) or regional lymph node (central or lateral) recurrence generally is associated with morbidity. Therefore, we analyzed overall loco-regional recurrence and locoregional recurrence outside of the contralateral remnant lobe separately. Methods. We retrospectively reviewed 8,676 conventional patients with papillary thyroid microcarcinoma who underwent thyroidectomy. Results. Lobectomy was performed in 3,289 (37.9%) patients, and total thyroidectomy was performed in 5,387 (62.1%) patients. Total thyroidectomy significantly decreased the risk of overall loco-regional recurrence (adjusted hazard ratio 0.398, P < .001). However, total thyroidectomy did not significantly decrease the risk of loco-regional recurrence outside of the contralateral remnant lobe (adjusted hazard ratio 0.880, P = .640). Particularly in conventional papillary thyroid microcarcinoma patients with multifocality, total thyroidectomy significantly decreased the risk of overall loco-regional recurrence (adjusted hazard ratio 0.284, P = .002) and loco-regional recurrence outside of the contralateral remnant lobe (adjusted hazard ratio 0.342, P = .020). Conclusion. Although lobectomy is associated with contralateral remnant lobe recurrence, lobectomy did not increase the risk of loco-regional recurrence outside of the contralateral remnant lobe in patients with papillary thyroid microcarcinoma, except in those with multifocality. Because recurrence in the contralateral remnant lobe can be managed safely by completion thyroidectomy, lobectomy may be a safe operative option for select patients with papillary thyroid microcarcinoma without multifocality. (Surgery 2017;161:485-92.) From the Division of Breast and Endocrine Surgery, Department of Surgery,a Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; Department of Surgery,b Changwon Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Changwon; and Division of Breast and Endocrine Surgery, Department of Surgery,c Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea
Accepted for publication July 27, 2016. Reprint requests: Jee Soo Kim, MD, PhD, Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, South Korea. E-mail:
[email protected]. 0039-6060/$ - see front matter Ó 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.surg.2016.07.037
THE
CURRENT INCREASE IN THE INCIDENCE OF PAPILLARY
(PTC) is mainly due to early detection of papillary thyroid microcarcinoma (PTMC), which is defined as a carcinoma 0.5 Multifocality Absent Present Bilaterality Absent Present ETE Absent Microscopic CLT Absent Present Central LN metastasis Absent Present RAI ablation Mean ± SD (mCi)z Absent Present
Total No. (%)
LT No. (%)
TT No. (%)
P value
8,676 (100.0)
3,289 (37.9)
5,387 (62.1)
NA
7,057 (81.3) 1,619 (18.7)
2,578 (78.4) 711 (21.6)
4,479 (83.1) 908 (16.9)
