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. 2021 Nov;10(6):486-494.
doi: 10.1159/000510620. Epub 2020 Sep 29.

Long-Term Outcome of Lobectomy for Thyroid Cancer

Matthieu Bosset  1 , Maxime Bonjour  2 , Solène Castellnou  1 , Zakia Hafdi-Nejjari  3 , Claire Bournaud-Salinas  4 , Myriam Decaussin-Petrucci  5 , Jean Christophe Lifante  6   7 , Agnès Perrin  1 , Jean-Louis Peix  6 , Philippe Moulin  1   8 , Geneviève Sassolas  3 , Michel Pugeat  1 , Françoise Borson-Chazot  1   3   7
Affiliations

Long-Term Outcome of Lobectomy for Thyroid Cancer

Matthieu Bosset et al. Eur Thyroid J. 2021 Nov.

Abstract

Introduction: Recent guidelines of the American Thyroid Association (ATA) suggest that a lobectomy may be sufficient to treat low- to intermediate-risk patients with thyroid tumors ≤40 mm, without extrathyroidal extension or lymph node metastases. The present study aimed to evaluate long-term recurrence after lobectomy for differentiated thyroid cancer and to analyze factors associated with recurrence.

Methods: In this retrospective cohort study, patients who underwent a lobectomy for thyroid cancer in a tertiary center between 1970 and 2010 were included. The outcome was the proportion of pathology-confirmed thyroid cancer recurrence, assessed in the whole cohort or in subgroups according to tumor size (≤ or >40 mm).

Results: A total of 295 patients were included, and these were followed-up for a mean (standard deviation, SD) 19.1 (7.8) years (5,649 patient-years); 61 (20.7%) were male and the mean (SD) age at diagnosis was 39.7 (12) years. Histological subtype was papillary in 263 (89.2%) patients and mean cancer size was 22.9 (16.9) mm. According to the 2015 ATA guidelines, 271 (91.9%) cancers had a low risk of recurrence and 24 (8.1%) an intermediate risk. A reoperation was performed in 54 patients (18.3%) and recurrence was confirmed in 40 (13.6%), diagnosed for 55% of cases more than 10 years after their initial surgery. Among recurrent patients, 14 (4.8% of the cohort) were operated for a contralateral papillary thyroid microcarcinoma and 26 (8.8% of the cohort) for a locoregional or metastatic recurrence. Non-suspicious nodular recurrences were monitored without reoperation in 53 (18.0%) patients. At the end of follow-up, 282 (95.6%) patients were in remission. Tumors with locoregional or metastatic recurrence were more frequent among tumors with aggressive histology (19.2 vs. 4.1%, p = 0.015) and of intermediate risk category (28.6 vs. 7.1%, p = 0.018). Tumors >40 mm, which would have been treated by thyroidectomy according to the 2015 ATA guidelines criteria, were found in 34 (11.5%) patients and were associated with a higher frequency of recurrence (20.6 vs. 7.3%, p = 0.024) and less remission (85.3 vs. 96.9%, p = 0.001).

Conclusion: The outcome of thyroid cancer treated by lobectomy is very good, particularly for cancer ≤40 mm. A prolonged follow-up is required due to the risk of late recurrence.

Keywords: Cancer recurrence; Lobectomy; Papillary thyroid cancer; Thyroid cancer; Thyroid reoperation.

PubMed Disclaimer

Conflict of interest statement

The authors have nothing to disclose in the area of the study.

Figures

Fig. 1
Fig. 1
Outcome of the 295 patients who underwent thyroid lobectomy between 1970 and 2010. PTC, papillary thyroid cancer.
See this image and copyright information in PMC

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