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Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
Total versus hemithyroidectomy for microscopic papillary thyroid cancer.
M Gershinsky1, O Barnett-Griness, N Stein
1Department of Endocrinology, Linn Medical Center, General Health Services, 35 Rotchild st. Haifa, 35152, Israel. gershinsky@yahoo.com
Journal of Endocrinological Investigation
|September 29, 2011
Summary
For low-risk thyroid papillary microcarcinoma (PMC), hemithyroidectomy may be an option, though recurrence risk is higher. For all other PMC cases, total thyroidectomy is recommended for initial treatment.
Area of Science:
- Endocrinology
- Surgical Oncology
- Thyroid Cancer Research
Background:
- Thyroid papillary microcarcinoma (PMC) generally has a good prognosis without increased mortality.
- However, neck recurrences and distant metastases are known complications.
- This study compares surgical outcomes for PMC using total thyroidectomy versus hemithyroidectomy.
Purpose of the Study:
- To compare the efficacy and outcomes of total thyroidectomy versus hemithyroidectomy in treating thyroid papillary microcarcinoma (PMC).
- To evaluate recurrence rates, lymph node involvement, and extraglandular extension based on surgical approach.
- To provide evidence-based recommendations for the optimal surgical management of PMC.
Main Methods:
- A retrospective study involving 293 patients with PMC from two major Israeli medical centers.
- Patients underwent either total thyroidectomy (214) or hemithyroidectomy (79).
- Mean follow-up period was 7.2 years, with analysis of tumor characteristics, lymph node (LN) metastases, extraglandular extension, and recurrence incidence.
Main Results:
- Total thyroidectomy showed higher rates of lymph node metastases (24.8% vs 1.3%) and extraglandular extension (11.7% vs 3.8%) compared to hemithyroidectomy.
- Overall cumulative recurrence rates were similar (13.2% for total thyroidectomy vs 14.3% for hemithyroidectomy).
- In low-risk patients (monofocal, no LN involvement/extraglandular extension), hemithyroidectomy had a 10% recurrence rate, while total thyroidectomy had none. Locoregional recurrences were detected by ultrasound in all hemithyroidectomy cases versus 47.6% in total thyroidectomy cases.
Conclusions:
- Hemithyroidectomy can be considered for low-risk PMC patients (monofocal, no lymph node involvement), acknowledging a potentially higher recurrence risk.
- Total thyroidectomy is recommended as the initial treatment for all other PMC patients.
- Surgical strategy should be tailored based on individual patient risk factors and tumor characteristics.
