Locoregional recurrence is common in papillary thyroid cancer PTC and an optimal surgical treatment with respect to the multifocal nature of the disease stays controversial. It is a retrospective analytical study design. 209 diagnosed PTCs managed at our institute were grouped into macro-PTC with a size of dominant focus >1 cm (unifocal n = 106 and multifocal n = 64) and micro-PTMC if size of all foci was <1 cm; (unifocal n = 16 and multifocal PTMC n = 23). The primary endpoint is recurrence and tumor free survival in each of the four groups. Secondary endpoint is an assessment of a benefit of completion total thyroidectomy in terms of assignment of true focal status to an individual's PTC. The median follow-up was 4.1 years. Upon completion thyroidectomy, the tumor focality changed to multifocal in 31.4% of macro-PTC and 60% of micro-PTMC. Multifocality was an independent risk factor for recurrence, OR 2.41 for macro (CI 1.14-5.11), and 3.48 for micro-multifocal PTMC (CI 1.19-10.2). Disease free survival patterns on Kaplan-Meier's plots were alike for micro- and macro-unifocal groups, and similarly stayed comparable among the two multifocal groups. Our analysis showed that tumor multifocality rather than size is the significant factor determining prognosis; hence, total thyroidectomy is indicated for an optimal assessment of true focality in micro-PTC.
Introduction:
Total thyoidectomy has become the oncologic procedure of choice for differentiated thyroid cancers DTC. The aim of the present study was to evaluate the post-operative morbidity rates, in relation to the surgical extent of primary and redo-thyroid surgeries.
Patients and Methods:
A total of 331 adult patients who underwent thyroid gland surgery for a diagnosed DTC were included. 213 patients had a completion thyroidectomy, while 117 received a primary total thyroidectomy. Among the redo surgery group, 108 had surgery on the previously unexplored side of neck only, while 105 had repeat exploration and thyroid resection on the previously operated side as well. Length of hospital stay, post-operative hypocalcaemia, recurrent laryngeal nerve injury and tumour recurrence were used as primary outcome measures.
Results:
Comparing primary versus redo surgery, there was no statistically significant difference between the groups in terms of all four main outcome measures. After controlling for patient's age, T and N stage, length of follow up, and whether or not a neck node dissection was done, the opposite side only redo surgery was associated with a statistically significant shorter hospital stay and lesser risk of persistent hypocalcaemia. Performance of simultaneous neck dissections was found to be associated with longer hospital stay (P ≤ 0.01). Higher initial N stage has a higher likelihood of development of loco regional and metastatic recurrence (P < 0.05)
Conclusion:
Analysis of our data suggest that under uniform conditions of tumour stage, surgeon, demographics and T stage, there is no statistically significant difference in post-operative outcomes between primary or completion total thyroidectomy. However, less extensive surgery is associated with a better perioperative outcome.
Highlights:
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