Long-Term Outcome after Hemithyroidectomy for Papillary Thyroid Cancer: A Comparative Study and Review of the Literature

Abstract

Background: The extent of surgery for differentiated thyroid cancer (DTC) remains a controversial issue. Since a less aggressive approach is becoming more predominant, we aim here to study the short- and long-term outcomes of DTC patients after hemithyroidectomy. Methods: From a total of 1252 consecutive papillary thyroid cancer (PTC) patients, 109 treated with hemithyroidectomy and 50 with total thyroidectomy but no I131 were included. Persistent or recurrent disease was defined based on histopathology, imaging studies, and thyroglobulin levels. Results: Our hemithyroidectomy cohort included females (84.4%), microcarcinomas (81.9%), TNM stage I (95.4%), and a low American Thyroid Association (ATA) recurrence risk (94.5%). At one-year post-treatment, 3.7% had persistent disease (all female, median age 55 years, tumor size 7.5 mm). Recurrent disease was detected in 7.5% of those with excellent response at 1-year. With a follow-up of 8.6 years (1–48), all 109 patients were disease free at last visit, including the 11 patients (10.1%) who received additional treatment. Also, when comparing the hemi- and total thyroidectomy groups no significant differences were found in the rate of persistent and recurrent disease, overall mortality, and disease status at last visit. Conclusions: For properly selected low-risk PTC patients, hemithyroidectomy is a safe treatment option with a favorable long-term outcome.

Characteristics of Persistent or Recurrent Differentiated Thyroid Cancer

“…As for the ratio sex, it is comparable to that found in several studies where the female predominency has been remarked [2]. The papillary carcinoma predominency in our study is without surprise as it is also majority in several studies [2] [3] [4]. The rate of persistent or recurrent differentiated thyroid cancer in our series is 6.12%, low to the rates of the literature.…”

Personalized management of differentiated thyroid cancer in real life – practical guidance from a multidisciplinary panel of experts

“…Overall, we agree with the ATA 2015 recommendations on neck dissection and total thyroidectomy in intermediate- to high-risk DTC; however, the use of lobectomy for low- to intermediate-primary tumors ≤4 cm may be too broad. Current controversies on the extent of surgery probably arise from heterogeneous studies [ 23 ]. Notably, the risk for local and distant metastases increases with increasing size of the papillary thyroid cancer (PTC), especially if the tumor size exceeds 2 cm, as has been described in an observational study involving 366 patients with PTC [ 24 ].…”

Total Thyroidectomy Versus Lobectomy for Thyroid Cancer: Single-Center Data and Literature Review

“…Controversies remain about the ideal surgical approach because some studies show a higher prevalence of persistent/recurrent disease among patients treated by lobectomy (LT) than among those treated by total thyroidectomy (TT), [3][4][5][6][7] whereas other studies find no significant differences in either disease-free survival (DFS) or overall survival (OS). [8][9][10][11][12][13][14][15][16][17][18][19] Nevertheless, data in the literature come from a limited number of centers, and very few studies include patients classified according to the American Thyroid Association (ATA) risk stratification system. 10,13,14,17,18 Because follow-up strategies, based primarily on thyroglobulin (Tg) determination, are less reliable for patients treated with LT, TT has been and still is considered the gold standard for the treatment of DTC, and a less aggressive surgical treatment is usually reserved for very-low-risk cases.…”

“…[8][9][10][11][12][13][14][15][16][17][18][19] Nevertheless, data in the literature come from a limited number of centers, and very few studies include patients classified according to the American Thyroid Association (ATA) risk stratification system. 10,13,14,17,18 Because follow-up strategies, based primarily on thyroglobulin (Tg) determination, are less reliable for patients treated with LT, TT has been and still is considered the gold standard for the treatment of DTC, and a less aggressive surgical treatment is usually reserved for very-low-risk cases. Consequently, the vast majority of data available on the comparison between the two surgical procedures have been obtained in micro papillary thyroid cancers.…”