Should multifocality be an indication for completion thyroidectomy in papillary thyroid carcinoma?

Harries, Victoria; Wang, Laura Y.; McGill, Marlena; Xu, Bin; Tuttle, R. Michael; Wong, Richard J.; Shaha, Ashok R.; Shah, Jatin P.; Ghossein, Ronald; Patel, Snehal G.; Ganly, Ian

doi:10.1016/j.surg.2019.03.031

Cited by 58 publications

(40 citation statements)

References 25 publications

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“…One area of active debate includes the extent of thyroidectomy surgery between lobectomy and possibly CT and TT. 11,15 An important consideration in preoperative planning is risk of postoperative complications. In this national study, we sought to analyze rates of non–thyroid-specific postoperative complications in CT and TT with the goal of capturing uncommon complications that are evident with only a large multi-institutional cohort.…”

Section: Discussionmentioning

confidence: 99%

A National Comparison of Postoperative Outcomes in Completion Thyroidectomy and Total Thyroidectomy

Brauer

Reddy

Burkey

et al. 2020

Otolaryngol.--head neck surg.

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Objective To characterize and assess the non–thyroid-specific postoperative complications of completion thyroidectomy as compared with total thyroidectomy. Study Design Retrospective analysis: 2005 to 2017. Setting National Surgical Quality Improvement Program database. Subjects and Methods Patients aged >18 years receiving a completion or total thyroidectomy were eligible for inclusion. Patients not treated by otolaryngologists or general surgeons and with unknown demographic variables were excluded. Results A total of 70,638 patients were analyzed, representing 64,763 total thyroidectomies and 5875 completion thyroidectomies. The 30-day mortality rate was 0.1% for both procedures ( P > .05). Overall, 1.7% and 1.4% of patients undergoing total and completion thyroidectomies experienced at least 1 complication ( P > .05), while 1.2% and 0.9% had a postoperative medical complication ( P = .0186), respectively. On multivariable analysis, patients undergoing total thyroidectomies were significantly more likely to return to the operating room (odds ratio [OR], 1.36; 95% CI, 1.04-1.80; P = .027) and to be readmitted (OR, 1.45; 95% CI, 1.16-1.81; P = .001). Adjusted analysis also demonstrated that patients undergoing total thyroidectomies were more likely to be inpatients (OR, 1.17; 95% CI, 1.11-1.24; P < .001), be treated by nonotolaryngologists (OR, 1.36; 95% CI, 1.29-1.45; P < .001), and smoke (OR, 1.22; 95% CI, 1.13-1.33; P < .001). Conclusion National data suggest that total and completion thyroidectomies are relatively safe procedures but that completion thyroidectomies are associated with lower rates of postoperative complications. These findings may play a role in determining treatment plans for patients and optimizing risk reduction.

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Section: Discussionmentioning

confidence: 99%

A National Comparison of Postoperative Outcomes in Completion Thyroidectomy and Total Thyroidectomy

Brauer

Reddy

Burkey

et al. 2020

Otolaryngol.--head neck surg.

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“…As multifocality in PTC more commonly occurs incidentally as microscopic foci diagnosed on histology report, occult tumors may be missed when performing RFA. However, patients with unifocal and multifocal disease had similar outcomes [39]. Regardless of the fact that CNB was performed in all patients prior to RFA, it cannot eliminate aggressive variants of PTC.…”

Section: Discussionmentioning

confidence: 95%

Ultrasonography-guided radiofrequency ablation for the treatment of T2N0M0 papillary thyroid carcinoma: a preliminary study

Xiao

Zhang

et al. 2021

International Journal of Hyperthermia

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Purpose: To evaluate the efficacy and safety of ultrasonography (US)-guided radiofrequency ablation (RFA) for treating T2N0M0 papillary thyroid cancer (PTC). Methods: This retrospective study was approved by the ethics committee of Chinese PLA General Hospital (S2019-211-01). Twelve patients with T2N0M0 PTC (five men and seven women with a mean age of 41.0 ± 9.2 years (range, 21-61 years)), who were not eligible for or refused surgery, were included in our study. RFA was performed with the moving-shot technique, and the ablation area exceeded the tumor edge by at least 3 mm. US was performed before RFA, immediately, 1, 3 , 6 and 12 months after RFA, and every 6-12 months thereafter. Results: All tumors were ablated as planned. The mean follow-up duration was 24.1 ± 6.9 months (range, 13-33 months). The tumor volume decreased significantly from 4.4 ± 2.8 ml to 0.3 ± 0.5 ml, and the volume reduction rate (VRR) was (93.7 ± 7.6)% at the final follow-up with two tumors (16.7%) disappearing. New or recurrent tumors were not found, and no local or distant metastasis were detected during follow-up. No life-threatening or delayed complications were observed. Conclusion: RFA may be a potential alternative to surgery for the management of T2N0M0 PTC in select patients, especially for those who are ineligible for surgery.

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“…Only 3% of total patients with multifocal PTCs underwent lobectomy, and only one patient developed recurrence in the contralateral lobe. However, Harries et al showed that unifocal PTC and multifocal PTC patients had similar rates of recurrence of the contralateral lobe, regional recurrence, and overall survival with a median follow-up of 58 months (16). RAI-T also did not decrease the risk of recurrence in PTC (17).…”

Section: Discussionmentioning

confidence: 99%

The clinical importance of multifocality on tumor recurrence in papillary thyroid carcinoma

Kim¹

2021

Gland Surg

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Background: Although the origin of the multifocality of papillary thyroid carcinoma (PTC) is unclear, it is not unusual and has not been considered as an independent prognostic factor from several tumor staging systems. This study aims to evaluate whether the presence of multifocality is associated with PTC recurrence.Methods: We reviewed retrospectively detailed histological reports of PTC patients who underwent thyroidectomy from January 2000 through December 2010 at a single institution. We assessed the relationship between multifocality and other possible prognostic factors using binary logistic regression analysis. We compared recurrence by the Kaplan-Meier method (the log-rank test). We analyzed a prognostic factor for recurrence using Cox's proportional hazard model (the stepwise forward method).Results: We enrolled a total of 434 PTC patients (380 women and 54 men; mean age, 48 years). The median follow-up period was 10.2 years. Of all PTC patients enrolled, 135 patients (31%) had multifocal PTC. There was a significant association between multifocality and cervical lymph node (CLN) metastasis (P=0.01). Multivariate analyses showed a significant association between multifocality and CLN metastasis (P<0.001). Multifocal PTC patients had higher CLN metastasis and tumor recurrence than those with single PTC. There was a significant association between multifocality and tumor recurrence (P=0.03 by log-rank test), but it disappeared in multivariate analysis.Conclusions: Multifocality of PTC might be related to CLN metastasis and tumor recurrence.

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Should multifocality be an indication for completion thyroidectomy in papillary thyroid carcinoma?

Cited by 58 publications

References 25 publications

A National Comparison of Postoperative Outcomes in Completion Thyroidectomy and Total Thyroidectomy

A National Comparison of Postoperative Outcomes in Completion Thyroidectomy and Total Thyroidectomy

Ultrasonography-guided radiofrequency ablation for the treatment of T2N0M0 papillary thyroid carcinoma: a preliminary study

The clinical importance of multifocality on tumor recurrence in papillary thyroid carcinoma

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