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Partial Thyroidectomy With Incidental Metastatic Lymph Nodes.

Ehab Alameer1,2, Alana Eagan2, Daniel W Scholfield2

  • 1Department of Surgery, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia.

JAMA Otolaryngology-- Head & Neck Surgery
|November 16, 2023
PubMed
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For well-differentiated thyroid cancer, completion thyroidectomy may not be necessary for patients with incidental metastatic lymph nodes after partial thyroidectomy. Observation shows high recurrence-free survival, suggesting careful patient selection is key.

Area of Science:

  • Endocrinology
  • Surgical Oncology
  • Pathology

Background:

  • The necessity of completion thyroidectomy in patients with incidental metastatic lymph nodes after partial thyroidectomy remains uncertain.
  • This study addresses the outcomes of patients diagnosed with incidental metastatic lymph nodes post-partial thyroidectomy.

Purpose of the Study:

  • To investigate the outcomes of patients with incidental metastatic lymph nodes following partial thyroidectomy.
  • To evaluate the recurrence-free survival in patients observed without immediate completion thyroidectomy.

Main Methods:

  • Retrospective review of a prospectively maintained thyroid cancer database (1985-2015) from a tertiary referral cancer center.
  • Inclusion of 74 patients who underwent partial thyroidectomy and were observed without immediate completion thyroidectomy, plus 11 patients who had immediate completion thyroidectomy.

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  • Analysis of recurrence-free survival, disease-specific survival, and overall survival.

    • Main Results:

    • Among 74 observed patients (median age 39, 59% female), 70% were intermediate risk. With a median follow-up of 48.15 months, only 1 patient experienced regional recurrence.
    • Recurrence-free survival was 97.4%, disease-specific survival 100%, and overall survival 96.2%.
    • Patients undergoing immediate completion thyroidectomy had higher rates of aggressive tumor features like tall-cell variant papillary thyroid carcinoma and positive margins.

    Conclusions:

    • Completion thyroidectomy may not be essential for selected patients with incidental metastatic lymph nodes (N1a) after partial thyroidectomy for localized, well-differentiated thyroid cancer.
    • Observation without immediate completion thyroidectomy appears safe and effective in this patient group.
    • Careful patient selection is crucial when considering observation versus completion thyroidectomy.