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. 2020 Aug;40(4):254-261.
doi: 10.14639/0392-100X-N0608.

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

Luigi Di Filippo #  1 , Gioacchino Giugliano #  2 , Marta Tagliabue  2 , Sara Gandini  3 , Federica Sileo  1 , Agnese Allora  1 , Enrica Grosso  2 , Michele Proh  2 , Veronica Basso  2 , Donatella Scaglione  4 , Marco Federico Manzoni  1   2   5 , Mohssen Ansarin  2   5
Affiliations

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

Luigi Di Filippo et al. Acta Otorhinolaryngol Ital. 2020 Aug.

Abstract

Tiroidectomia totale versus emitiroidectomia: approccio chirurgico al carcinoma papillare della tiroide T1-T2.

Riassunto: Il carcinoma papillare della tiroide rappresenta l’80-90% dei tumori tiroidei e la sua incidenza è attualmente in aumento. Vogliamo valutare i risultati oncologici e funzionali del trattamento chirurgico del cancro della tiroide: tiroidectomia totale versus emitiroidectomia. Abbiamo effettuato uno studio monocentrico di coorte storica in un centro di riferimento terziario. Abbiamo raccolto i dati demografici, clinicopatologici e complicanze post operatorie di 586 pazienti trattati nel nostro istituto per carcinoma papillare della tiroide. Sono stati applicati modelli di rischio proporzionale Cox per valutare le differenze nei risultati, stratificandoli con il propensity score. I nostri dati suggeriscono che l’emitiroidectomia non porta ad un aumento del rischio di ricaduta locoregionale né a distanza rispetto alla tiroidectomia totale nei pazienti affetti da carcinoma in stadio T1-2 N0. La tiroidectomia totale riveste un ruolo importante in termini di miglioramento della prognosi nei casi di metastasi linfonodali del comparto centrale del collo (pN1a) (p = 0,001). Nella nostra casistica la tiroidectomia totale ha un rischio più elevato di complicanze chirurgiche in termini di ipocalcemia post operatoria e paralisi ricorrenziali (p < 0,001 e p = 0,02 rispettivamente).

Keywords: hypocalcaemia; papillary thyroid cancer; recurrent laryngeal nerve paralysis; thyroid lobectomy; total thyroidectomy.

Plain language 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).

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Figures

Figure 1.
Figure 1.
Recurrence-free survival (RFS) in patients receiving lymphadenectomy according to type of surgery: Total Thyroidectomy (TT) vs Thyroid Lobectomy (TL).
Figure 2.
Figure 2.
(A) recurrence-free survival (RFS) in patients receiving lymphadenectomy and pN+ according to type of surgery: Total Thyroidectomy (TT) vs Thyroid Lobectomy (TL); (B) recurrence-free survival (RFS) in patients receiving lymphadenectomy and pN− according to type of surgery: Total Thyroidectomy (TT) vs Thyroid Lobectomy (TL); (C) recurrence-free survival (RFS) in patients no receiving lymphadenectomy according to type of surgery: Total Thyroidectomy (TT) vs Thyroid Lobectomy (TL).
See this image and copyright information in PMC

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