Unilateral total lobectomy: Is it sufficient surgical treatment for patients with AMES low-risk papillary thyroid carcinoma?

Background: Controversy continues regarding the optimal extent of primary thyroid resection in most patients with papillary thyroid carcinoma (PTC), who are at minimal risk of cause-specific mortality (CSM). This study was designed to compare CSM and recurrence rates after either unilateral lobectom...

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Bibliographic Details
Published in:Surgery 1998-12, Vol.124 (6), p.958-966
Main Authors: Hay, Ian D., Grant, Clive S., Bergstralh, Erik J., Thompson, Geoffrey B., van Heerden, Jon A., Goellner, John R.
Format: Article
Language:English
Subjects:
Adult
Carcinoma, Papillary - epidemiology
Carcinoma, Papillary - secondary
Carcinoma, Papillary - surgery
Female
Humans
Male
Middle Aged
Neoplasm Recurrence, Local - epidemiology
Risk Assessment
Risk Factors
Survival Rate
Thyroid Neoplasms - epidemiology
Thyroid Neoplasms - surgery
Thyroidectomy - methods
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Summary:Background: Controversy continues regarding the optimal extent of primary thyroid resection in most patients with papillary thyroid carcinoma (PTC), who are at minimal risk of cause-specific mortality (CSM). This study was designed to compare CSM and recurrence rates after either unilateral lobectomy (UL) or bilateral lobar resection (BLR) in patients with PTC considered low risk by AMES criteria. Methods: Outcome was studied in 1685 patients initially treated during 1940 through 1991 and followed for up to 54 postoperative years (mean, 18 years). One thousand six hundred fifty-six patients (98%) had complete primary tumor resection; 634 (38%) had involvement of regional nodes. One hundred ninety-five patients (12%) had UL; BLR accounted for 1468 (near-total 60%; total thyroidectomy 18%). Results: Thirty-year rates for CSM and distant metastasis were 2% and 3%, respectively. Twenty-year rates for local recurrence and nodal metastasis were 4% and 8%, respectively. There were no significant differences in CSM or distant metastasis rates between UL and BLR ( P > .2). After UL, 20-year rates for local recurrence and nodal metastasis were 14% and 19%, significantly higher ( P = .0001) than the 2% and 6% rates seen after BLR. Conclusions: UL was not associated with higher CSM rates, but it was associated with a significantly higher risk of locoregional recurrence. Thus BLR probably represents a preferable initial surgical approach to patients with low-risk PTC. (Surgery 1998;124:958-66.)
ISSN:0039-6060
1532-7361
DOI:10.1016/S0039-6060(98)70035-2