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

Area of Science:

• Endocrinology
• Surgical Oncology
• Thyroid Cancer Research

Background:

• Multifocal papillary thyroid carcinoma is a frequent clinical finding.
• The necessity of completion thyroidectomy for multifocal disease remains debated.
• This study investigates outcomes after lobectomy alone for multifocal papillary thyroid carcinoma.

Purpose of the Study:

• To assess the risk of contralateral papillary thyroid carcinoma, regional recurrence, and survival in multifocal papillary thyroid carcinoma patients treated with lobectomy alone.
• To compare these outcomes with those of unifocal papillary thyroid carcinoma patients treated similarly.
• To inform treatment guidelines regarding completion thyroidectomy for multifocal papillary thyroid carcinoma.

Main Methods:

• Retrospective analysis of 849 papillary thyroid carcinoma patients treated with lobectomy alone between 1986 and 2015.
• Exclusion of patients with advanced disease (pT3-T4, nodal, or distant metastases).
• Kaplan-Meier analysis to calculate contralateral lobe papillary thyroid carcinoma-free probability, regional recurrence-free probability, and survival rates.

Main Results:

• No significant difference in 10-year contralateral lobe papillary thyroid carcinoma rates (98.6% vs 97.8%), regional recurrence (99.5% vs 99.4%), or overall survival (91.6% vs 93.1%) between unifocal and multifocal disease groups.
• Median follow-up was 58 months.
• No disease-related deaths were reported.

Conclusions:

• Lobectomy alone provides comparable outcomes to unifocal disease management for select multifocal papillary thyroid carcinoma patients.
• Multifocal papillary thyroid carcinoma should not automatically warrant completion thyroidectomy.
• Conservative management with lobectomy alone may be appropriate for carefully selected multifocal papillary thyroid carcinoma cases.