Background:The extent of surgery for papillary thyroid cancers (PTC) remains controversial. Consensus guidelines have recommended total thyroidectomy for PTC Ն1 cm; however, no study has supported this recommendation based on a survival advantage. The objective of this study was to examine whether the extent of surgery affects outcomes for PTC and to determine whether a size threshold could be identified above which total thyroidectomy is associated with improved outcomes. Methods: From the National Cancer Data Base (1985-1998), 52,173 patients underwent surgery for PTC. Survival was estimated by the Kaplan-Meier method and compared using log-rank tests. Cox Proportional Hazards modeling stratified by tumor size was used to assess the impact of surgical extent on outcomes and to identify a tumor size threshold above which total thyroidectomy is associated with an improvement in recurrence and long-term survival rates. Results: Of the 52,173 patients, 43,227 (82.9%) underwent total thyroidectomy, and 8946 (17.1%) underwent lobectomy. For PTC Ͻ1 cm extent of surgery did not impact recurrence or survival (P ϭ 0.24, P ϭ 0.83). For tumors Ն1 cm, lobectomy resulted in higher risk of recurrence and death (P ϭ 0.04, P ϭ 0.009). To minimize the influence of larger tumors, 1 to 2 cm lesions were examined separately: lobectomy again resulted in a higher risk of recurrence and death (P ϭ 0.04, P ϭ 0.04).
Conclusions:The results of this study demonstrate that total thyroidectomy results in lower recurrence rates and improved survival for PTC Ն1.0 cm compared with lobectomy. This is the first study to demonstrate that total thyroidectomy for PTC Ն1.0 cm improves outcomes.
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