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Abraham PJ, Wu C, Wang R, Herring B, Zmijewski P, Gillis A, Fazendin J, Lindeman B, Chen H. The overtreatment of papillary thyroid microcarcinoma in the community. Am J Surg 2024; 233:132-135. [PMID: 38462410 PMCID: PMC11325562 DOI: 10.1016/j.amjsurg.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/20/2024] [Accepted: 03/03/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Total thyroidectomy is the traditional primary approach for papillary thyroid cancer. However, recent evidence supports conservative management for low-risk tumors like papillary thyroid microcarcinomas (PTMCs). This study explores the adoption of these practices in our community, using a cancer database to analyze treatment strategies. METHODS A retrospective review of a 1433-patient institutional database identified 258 PTMC cases. Outcomes, including 30-day mortality, reoperation rate, postoperative hypocalcemia, and recurrent laryngeal nerve (RLN) injury, were assessed. RESULTS Of PTMC patients, 63.4% underwent total thyroidectomy, with higher rates of RLN injury (8.8% vs. 2.3%) and hypocalcemia (12.4% vs. 0.0%) compared to lobectomy. Non-endocrine surgeons had higher postoperative radioactive iodine administration rates (28.6% vs. 6.1%). Subgroup analysis revealed a shift in total thyroidectomy rates based on tumor size and surgery period. CONCLUSION Our community favors total thyroidectomy for PTMC, despite associated complications. Enhanced awareness and adherence to PTMC best practice guidelines are warranted.
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Affiliation(s)
- Peter J Abraham
- University of Alabama at Birmingham, Department of General Surgery, Birmingham, AL, USA
| | - Christopher Wu
- University of Alabama at Birmingham, Department of General Surgery, Birmingham, AL, USA
| | - Rongzhi Wang
- University of Alabama at Birmingham, Department of General Surgery, Birmingham, AL, USA
| | - Brendon Herring
- University of Alabama at Birmingham, Department of General Surgery, Birmingham, AL, USA
| | - Polina Zmijewski
- University of Alabama at Birmingham, Department of General Surgery, Birmingham, AL, USA
| | - Andrea Gillis
- University of Alabama at Birmingham, Department of General Surgery, Birmingham, AL, USA
| | - Jessica Fazendin
- University of Alabama at Birmingham, Department of General Surgery, Birmingham, AL, USA
| | - Brenessa Lindeman
- University of Alabama at Birmingham, Department of General Surgery, Birmingham, AL, USA
| | - Herbert Chen
- University of Alabama at Birmingham, Department of General Surgery, Birmingham, AL, USA.
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Back K, Lee J, Cho A, Choe JH, Kim JH, Oh YL, Kim JS. Is total thyroidectomy with bilateral central neck dissection the only surgery for papillary thyroid carcinoma patients with clinically involved central nodes? BMC Surg 2022; 22:251. [PMID: 35768863 PMCID: PMC9245244 DOI: 10.1186/s12893-022-01699-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background In clinical practice, we often observed that patients who underwent total thyroidectomy due to clinically involved nodal disease (cN1a) actually had less extensive CLNM on final pathology. This study investigates whether total thyroidectomy and therapeutic bilateral CND are necessary for all PTC patients with cN1a.
Methods This study retrospectively reviewed 899 PTC patients who underwent total thyroidectomy with bilateral CND from January 2012 to June 2017. The patients were divided into two groups according to pre-operative central lymph node (CLN) status: cN0, no suspicious CLNM; cN1a, suspicious CLNM. We compared the clinicopathological features of these two groups. Results There was no significant difference in recurrence between cN0 and cN1a groups after a mean follow-up time of 59.1 months. Unilateral cN1a was related to the largest central LN size ≥ 2 mm (OR = 3.67, p < 0.001) and number of CLNM > 5(OR = 2.24, p = 0.006). On the other hand, unilateral cN1a was not associated with an increased risk of contralateral lobe involvement (OR = 1.35, p = 0.364) and contralateral CLNM (OR = 1.31, p = 0.359). Among 106 unilateral cN1a patients, 33 (31.1%) were found to be pN0 or had ≤ 5 metastatic CLNs with the largest node smaller than 2 mm. Conclusions Most cN1a patients were in an intermediate risk group for recurrence and required total thyroidectomy. However, lobectomy with CND should have performed in approximately 30% of the cN1a patients. Pre-operative clinical examination, meticulous radiologic evaluation, and intra-operative frozen sections to check the nodal status are prerequisites for this approach.
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Affiliation(s)
- Kyorim Back
- Division of Endocrine Surgery, Department of Surgery, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, South Korea
| | - Jiyeon Lee
- Department of Pathology and Translational Genomics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Anna Cho
- Division of Endocrine Surgery, Department of Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jun-Ho Choe
- Division of Endocrine Surgery, Department of Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Jung-Han Kim
- Division of Endocrine Surgery, Department of Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea
| | - Young Lyun Oh
- Department of Pathology and Translational Genomics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Jee Soo Kim
- Division of Endocrine Surgery, Department of Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
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Chen H. From the Editor – in – Chief: Featured papers in the April 2022 issue. Am J Surg 2022; 223:607. [DOI: 10.1016/j.amjsurg.2022.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Zmijewski P, Kuo LE. Can less Be more in the treatment of cN1a papillary thyroid microcarcinoma? Am J Surg 2021; 223:633-634. [PMID: 34756456 DOI: 10.1016/j.amjsurg.2021.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/01/2022]
Affiliation(s)
- Polina Zmijewski
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Lindsay E Kuo
- Department of Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, PA, USA.
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