Surgical treatment for dominant malignant nodules of the isthmus of the thyroid gland: A case control study

Karatzas, Theodore; Charitoudis, Georgios; Vasileiadis, Dimitrios; Kapetanakis, Stylianos; Vasileiadis, Ioannis

doi:10.1016/j.ijsu.2015.04.039

Cited by 46 publications

(67 citation statements)

References 22 publications

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“…The thyroid isthmus is the central part of the thyroid gland and lies anterior to the trachea, overlying the second to fourth tracheal rings and being covered by the strap muscles, fascia, and skin in the middle of the neck 8. The rate of differentiated carcinoma located in the isthmus was reported to range from 1% to 9.2% for all thyroid malignant carcinoma nodules 9,10.…”

Section: Discussionmentioning

confidence: 99%

“…Until now, the extent of appropriate surgical resection for PTCs located in the isthmus has remained a matter of considerable debate; furthermore, no consensus exists in the guidelines for the surgical protocol of PTCs confined to the isthmus. Most previous studies support total thyroidectomy as the standard surgical protocol for PTCs located in the isthmus 8–10. However, Nixon et al10 reported that cases with PTC nodules confined to the isthmus without evidence of extraglandular extension may be suitable for thyroid isthmusectomy or wide field isthmusectomy due to the reduced chance of damaging the recurrent laryngeal nerve and parathyroid glands without exposing the tracheoesophageal grooves.…”

Section: Discussionmentioning

confidence: 99%

“…Some researchers argue that PTCs located in the isthmus are more likely to be associated with multifocal disease, lymph node involvement, and capsule invasion, thus supporting total thyroidectomy as the first-choice treatment for these patients 8,9. However, some opposing conclusions have been proposed; for instance, isthmusectomy alone may be sufficient because this approach does not require exploration of the tracheoesophageal grooves and thus reduces the postoperative complications and operating time 10.…”

Section: Introductionmentioning

confidence: 99%

“…Few reports exist in the literature on thyroid isthmusectomy; most series include only small numbers of malignant lesions, and no consistent conclusions have been drawn 8–10. This study was designed to analyze the outcomes (tumor recurrence and postoperative complications) of different surgical protocols.…”

Section: Introductionmentioning

confidence: 99%

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Surgical procedures for papillary thyroid carcinoma located in the thyroid isthmus: an intention-to-treat analysis

Lei¹,

Zhu

et al. 2016

OTT

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ObjectiveWe sought to evaluate and compare the outcomes of different surgical protocols for papillary thyroid cancer (PTC) located in the isthmus in a retrospective intention-to-treat analysis.Patients and methodsThe data of 3,068 patients who received thyroidectomy due to thyroid cancer in our center were reviewed. Of these, 103 patients had a dominant carcinoma located in the isthmus. Various baseline and tumor characteristics and surgical outcomes were evaluated and compared with respect to the different surgical protocols (85 cases with total thyroidectomy and 18 cases with less-than-total thyroidectomy). Univariate and multivariate analyses were performed to identify resected patients who developed recurrence with isthmic PTC.ResultsThe postoperative complication rates were comparable between the two groups (17.6% versus 11.1%, P=0.500). Although the total thyroidectomy group showed a much higher rate (P=0.004) and number (P<0.001) of parathyroidectomies, long-term follow-up indicated that parathyroid autotransplantation did not significantly damage the function of the parathyroid (P>0.05). Tumor recurrence was observed in five patients, including two patients in the total thyroidectomy group and three patients in the less-than-total thyroidectomy group; the tumor recurrence rate in the total thyroidectomy group was significantly lower than that in the less-than-total thyroidectomy group (P=0.040). Univariate and multivariate analyses indicated less-than-total thyroidectomy as a risk factor for tumor recurrence in PTC cases with tumors located at the isthmus (hazard ratio: 1.870, 95% confidence interval: 1.320–2.218, P<0.001).ConclusionOur findings indicate that total thyroidectomy is an appropriate initial surgical protocol for isthmic PTC due to the lower recurrence rate, comparable postoperative complication rate, and parathyroid function recovery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical procedures for papillary thyroid carcinoma located in the thyroid isthmus: an intention-to-treat analysis

Lei¹,

Zhu

et al. 2016

OTT

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“…demonstrated within a range of 1% to 9.2% [1] [2] [3] [4]. There have been no specific guidelines for the surgical treatment of patients with papillary carcinoma arising in the isthmus [5] [6] [7].…”

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confidence: 99%

Treatment Outcome of Papillary Carcinoma Confined to the Thyroid Isthmus

Huang¹,

Liu²,

Song³

et al. 2016

JCT

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Objective: The purpose of this study is to evaluate the clinicopathologic characteristics and treatment outcomes of Papillary Thyroid Carcinomas (PTC) of the isthmus and to establish an appropriate surgical strategy. Methods: Thirty-four patients with PTC in isthmus are managed by surgery in National Cancer Center/Cancer Hospital of Chinese Academy of Medical Sciences, Peking Union Medical College from . Demographic data, surgical procedures, pathological features, stages and outcomes are analyzed. Results: Seven patients were men and 27 were women. The median age was 41 years (range, 20 -71). Twenty-five patients were treated with thyroid isthmusectomy or wide field isthmusectomy, five with hemithyroidectomy (lobectomy and isthmusectomy) and four with hemithyroidectomy and partial resection of the contralateral lobe. Twenty-eight patients had a pathologically T1 lesion (pT1); two patients had a pT2 lesion and four had a pT3 lesion. Five patients (14.7%) had papillary carcinoma detected in one of the pretracheal lymph nodes. Thirty-two patients had a solitary lesion confined to the thyroid isthmus. One patient had two lesions in the thyroid isthmus and another one had two lesions located in the thyroid isthmus and right lobe respectively. With a median follow-up of 94 months (range, 12 -274), two patients had a recurrence and both survived after a re-operation. There was no regional lymph node or distant organ recurrences. No deaths occurred. Conclusions: Isthmusectomy or wide field isthmusectomy could be a sufficient treatment for PTC confined to the thyroid isthmus. We also recommend that pretracheal lymph node dissection be considered.

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Investigating the impact of tumor location and size on the risk of recurrence for papillary thyroid carcinoma in the isthmus

Feng

Xie

et al. 2023

Cancer Medicine

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Background The purpose of the study was to investigate the ability of new parameters in distinguishing high‐risk patients of recurrence from isthmic papillary thyroid carcinomas (iPTCs). Methods One hundred sixteen iPTC patients who underwent total thyroidectomy were identified from 3461 PTC patients from 2014 to 2019. Tumor margin to trachea midline distance (TTD), maximum tumor size (TS), and transverse diameter of trachea (TD) were measured on CT images. Cox proportional hazard models served to identify risk factors associated with recurrence‐free survival (RFS). The iPTC prognostic formula (IPF = TD/(TTD − TS) − TD/TTD) was evaluated to assess the prognosis. RFS was conducted between the different groups using the Kaplan–Meier analysis. The receiver operating characteristic (ROC) curve of each parameter was drawn to predict recurrence. Results Central lymph node metastasis (CLNM) and extrathyroidal invasion in iPTC were 58.6% and 31.0%, respectively. Regional recurrence occurred in 16 (13.8%) patients, and no patient died or had distant metastasis. The 3‐ and 5‐year RFS of iPTC were 87.5% and 84.5%, respectively. Gender (p = 0.001) and PLNM (prelaryngeal lymph node metastasis) (p = 0.010) in cPTC (center of iPTC located between two imaginary lines perpendicular to the surface of the skin from the most lateral points of the trachea) and non‐cPTC (iPTC patients enrolled in this study excluding cPTC) groups differed significantly. A cut‐off point of tumor size >1.1 cm and IPF ≤5.57 were established to have significant differences in prognosis (p = 0.032 and p = 0.005, respectively). Multivariate analysis showed that IPF ≤5.57 was independent prognostic factor for RFS (HR: 4.415, 95%CI: 1.118–17.431, p = 0.034). Conclusion This study indicated the association between IPF and RFS in iPTC patients and established new models to assess risk factors for recurrence pre‐operation. IPF ≤5.57 was significantly associated with poor RFS and might be promising parameters for predicting prognosis and surgical decision‐making pre‐operation.

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Surgical treatment for dominant malignant nodules of the isthmus of the thyroid gland: A case control study

Cited by 46 publications

References 22 publications

Surgical procedures for papillary thyroid carcinoma located in the thyroid isthmus: an intention-to-treat analysis

Surgical procedures for papillary thyroid carcinoma located in the thyroid isthmus: an intention-to-treat analysis

Treatment Outcome of Papillary Carcinoma Confined to the Thyroid Isthmus

Investigating the impact of tumor location and size on the risk of recurrence for papillary thyroid carcinoma in the isthmus

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