Total thyroidectomy may be more reasonable as initial surgery in unilateral multifocal papillary thyroid microcarcinoma: a single-center experience

Abstract

BackgroundThe extent of surgery in patients with unilateral multifocal papillary thyroid microcarcinoma (UMPTMC) remains to be controversial. Aimed to improve surgical management of UMPTMC, this study was performed to identify the recurrence of UMPTMC and analyze its predictive factors.MethodsThis study was approved by the Ethical Committee of The First Hospital of the Jilin University, and written informed consent was given by participants for their clinical records to be used in this study. We retrospectively analyzed a total of 97 consecutive patients who underwent initial surgery for the treatment of UMPTMC at The First Hospital of Jilin University, between October 2005 and October 2006.ResultsAltogether, 97 patients of UMPTMC have been enrolled in our study, in which 57 cases were performed with hemithyroidectomy (HT) while other 40 cases with total thyroidectomy (TT). The sum diameter of all tumors >1 cm was more frequent in HT group than in TT group (40.35 vs 20%; p = 0.046). Positive central lymph nodes were found more frequently in the TT patients than in the HT patients (80 vs 59.65%; p = 0.046). Tumor recurrence was seen more frequently in the HT cases than in the TT cases (26 vs 5%; p = 0.007). The disease-free survival period was significantly shorter for the HT patients than for the TT patients (p = 0.0059 by the log-rank test). The disease-free survival rates at 5 and 10 years were 91.23 and 73.68%, respectively, in the HT group and 100 and 92.5%, respectively, in the TT group. Univariate analysis by Cox’s proportional hazards method showed male gender, sum diameter of all tumors >1 cm, and central lymph node metastases (CLNM) to be risk factors for recurrence of HT patients. Male gender and sum diameter >1 cm were factors identified for multivariate analysis by Cox’s proportional hazards method which yielded risk ratios of 3.037 [CI 1.026–8.988; p = 0.045] and 5.475 [CI 1.389–21.572; p = 0.015] in the HT group.ConclusionsIn summary, with an increased risk of recurrence, TT may be more reasonable as initial surgery in UMPTMC, especially with male gender and total tumor diameter greater than 1 cm.Electronic supplementary materialThe online version of this article (doi:10.1186/s12957-017-1130-7) contains supplementary material, which is available to authorized users.

The Effect of Prophylactic Central Neck Dissection During Hemithyroidectomy on Locoregional Recurrence in Patients With Papillary Thyroid Carcinoma: A Meta-Analysis

“…1). Table 1 summarizes the outcomes of the 14 studies that were ultimately included in the analysis [10][11][12][13][14][15][16][17][18][19][20][21][22][23]. Two studies investigated the impact of prophylactic central neck dissection in hemithyroidectomy using a comparative method [11,19].…”

“…Two studies investigated the impact of prophylactic central neck dissection in hemithyroidectomy using a comparative method [11,19]. Six investigations compared oncological results between total thyroidectomy and hemithyroidectomy in various subjects; however, only the data regarding hemithyroidectomy were included in the present study [10,12,13,20,21,23]. Others compared recurrence according to various factors among patients who underwent hemithyroidectomy [14][15][16][17][18]22].…”

Lymph Node Metastasis and Extrathyroidal Extension in Papillary Thyroid Microcarcinoma in Cyprus: Suspicious Subcentimeter Nodules Should Undergo FNA When Multifocality is Suspected

“…Total thyroidectomy or hemithyroidectomy is the current standard of practice with the latest ATA guidelines favouring towards hemithyroidectomy for PTMC without aggressive features [11,16]. However, many surgeons suggest total thyroidectomy as the first option as more metastatic LN can be identified during total thyroidectomy with central LN dissection [16][17][18]. In addition, total thyroidectomy improves postoperative follow-up surveillance through the use of serum thyroglobulin and decreases the risk of reoccurrence [16].…”

“…However, many surgeons suggest total thyroidectomy as the first option as more metastatic LN can be identified during total thyroidectomy with central LN dissection [16][17][18]. In addition, total thyroidectomy improves postoperative follow-up surveillance through the use of serum thyroglobulin and decreases the risk of reoccurrence [16]. Furthermore, when indicated, it facilitates the use of postoperative radioactive iodine ablation [19].…”

“…Central LN metastasis can occur in up to 29.3% and lateral lymph node metastasis in 3.7-5.6% of PTMC patients [20][21][22], and this is associated with locoregional re-occurrence and adverse outcomes [23,24]. ETE is another risk factor that can affect the decision for total vs. hemithyroidectomy [16,25]. ETE can occur in 28.0-40.3% of PTMC patients [26,27] and is associated with increased likelihood of central, lateral LN metastasis, and increased tumor size and should be treated more aggressively [28,29].…”