Low-risk papillary thyroid carcinoma patients who underwent near-total thyroidectomy without prophylactic central compartment lymph node dissection and were ablated with low-dose 50mCi RAI had excellent 10-year prognosis

Abstract

BAcKgrounD: The current trend in the management of low risk differentiated thyroid carcinoma is to follow less aggressive strategies. oBjEcTIVE: To assess the long-term morbidity and mortality outcomes of low-risk papillary thyroid carcinoma (pTc) patients undergoing minimal intervention. DEsIgn: we retrospectively analyzed 137 patients with low-risk pTc (stage I: n=77; stage II: n=60). of these patients, 107 (group 1) had macro-pTc and underwent near-total thyroidectomy and received postoperatively 50mci rAI. The remaining 30 patients (group 2) had micro-pTc (<1cm) and were treated only by means of near-total thyroidectomy. rEsulTs: The median follow-up for group 1 patients was 10 years (range: 3-30). At 1-year evaluation, 8 patients of group 1 had indeterminate or incomplete biochemical response, of whom 4 had also incomplete structural response to initial therapy. only 1 of 4 patients with structural incomplete response underwent cervical lymph node dissection and then received an additional dose of 100mci rAI. The remaining 7 patients received only an additional dose of 100mci rAI. These patients have been continuously followed till the present time with no recurrences or deaths (median follow-up: 17.5 years; 3-30 years). At 15 years, 2 patients of group 1 experienced biochemical recurrence and they received 100mci rAI. Three patients of group 2 experienced recurrence, with 2 receiving 50mci rAI and 1 undergoing cervical lymph node dissection with 50mci rAI. conclusIons: patients with low-risk macro-pTc treated by means of near-total thyroidectomy without pcclnD and receiving postoperatively a low dose of 50mci rAI have excellent long-term prognosis.