Total thyroidectomy versus lobectomy: surgical approach to T1-T2 papillary thyroid cancer

Abstract

SUMMARY The incidence of papillary thyroid carcinoma, which accounts for 80-90% of all thyroid cancers, has recently been increasing. The current study aimed to compare the oncological and functional outcomes of total thyroidectomy (TT) and thyroid lobectomy (TL). To this end, a retrospective single-centre cohort study involving a tertiary care institution was conducted. Data regarding demographics, clinicopathology and postoperative complications from 586 patients with papillary thyroid cancer treated in a single institution were collected. Cox proportional-hazards models were utilised to determine differences in outcomes stratified according to propensity score. Our data suggested no significant difference in the risk for locoregional recurrence or distant metastasis between TL and TT among patients with pT1-2 pN0 papillary carcinoma. TT plays an important role in improving prognosis among patients with metastatic lymph nodes in the central neck compartment (pN1a) (p = 0.001). Moreover, TT had significantly higher rates of postoperative hypocalcaemia and recurrent laryngeal nerve paralysis compared to TL (p < 0.001 and p = 0.02, respectively).

Prevalence of Central Compartment Lymph Node Metastases in Papillary Thyroid Micro-Carcinoma: A Retrospective Evaluation of Predictive Preoperative Features

“…This restriction is largely due to the high postoperative complications rate after thyroid surgery plus lymph node dissection performed in centers with limited experience. Indeed, in high-volume centers, it seems that prophylactic central lymph node dissection doesn’t influence the postoperative complications rate, as confirm our results and other published papers [ 67 , 68 , 73 , 74 , 75 ].…”

“…In most cases, only a less-radical surgical treatment, ultrasound-guided minimally invasive treatments, or an observational approach alone is recommended. Some authors have underlined that observation alone or surgery with conservative treatment (lobectomy) should be performed for low-risk tumors if they show neither unfavorable features nor the clinical suspicion of nodal metastases [ 12 , 29 , 68 ]. Recently, in some centers, minimally invasive treatments have been successfully used in the treatment of PTMCs as an alternative to active surveillance, in cases with no suspected LNM and no evidence of capsular involvement [ 27 , 69 ].…”

“…Based on these preoperative features of PTMCs, tailored treatment strategies including active surveillance, ultrasound-guided minimally invasive treatments, lobectomy, or total thyroidectomy with or without central lymph node dissection should be carefully considered [ 25 , 26 ]. Central compartment lymph node dissection can be achieved with low morbidity in experienced hands, and with a very low rate of complications such as hypoparathyroidism and recurrent laryngeal nerve injury [ 68 ]. For patients with papillary thyroid micro-carcinoma, the presence of these factors should be considered as risks for CLNM, and, in these cases, a prophylactic routine central compartment (level VI) neck dissection should be planned.…”

Impact of thyroid cancer treatment on assisted reproductive technology outcomes in women with infertility

“…Aside from the H-P-T axis damage, hypocalcemia and vitamin D deficiency may also be associated with adverse IVF/ICSI outcomes. Filippo et al reported a nearly 3-fold higher hypocalcemia risk in patients who underwent total thyroidectomy than in patients who underwent lobectomy [ 18 ]. Vitamin D plays a pivotal role in regulating calcium metabolism, and a recent study showed a significant association between postoperative hypocalcemia and low preoperative vitamin D levels in patients after total thyroidectomy [ 19 ].…”

Thyroid Lobectomy is Frequently Inappropriate for Many T1b–T2 Papillary Thyroid Cancers with High-Risk Features

“…Thyroid cancer is one of the most rapidly increasing cancers globally, and papillary thyroid cancers (PTCs) make up 80 to 90% of this incidence (1). Until recently, the standard treatment for thyroid cancer of any size was total thyroidectomy; however, a robust literature has shown equivalent outcomes with total thyroidectomy and thyroid lobectomy, leading the American Thyroid Association (ATA) and other associations to recommend thyroid lobectomy for PTCs measuring up to 4 cm (1,2).…”