J Korean Surg Soc.  2012 Oct;83(4):196-202. 10.4174/jkss.2012.83.4.196.

Observational study of central metastases following thyroid lobectomy without a completion thyroidectomy for papillary carcinoma

• Cho JS
• Yoon JH
• Park MH
• Shin SH
• Jegal YJ
• Lee JS
• Kim HK

• KMID: 2212303
• DOI: http://doi.org/10.4174/jkss.2012.83.4.196

Abstract

PURPOSE
There are no guidelines for the optimal timing of the decision of when to perform completion thyroidectomy, and controversy exists regarding how the timing of completion thyroidectomy impacts survival patterns. We investigated the legitimacy of an observational strategy in central node metastasis after thyroid lobectomy for papillary thyroid cancer (PTC).
METHODS
We retrospectively evaluated 522 consecutive patients who underwent thyroid lobectomy. Of the 69 patients with central metastasis, 61 patients (88.4%) were included in an observational study under cautious evaluation with informed consent by the patients, and compared with an observation arm of 180 postlobectomy N0 (node negative proven) patients.
RESULTS
Of the 522 patients, six (1.1%) thyroid, five (0.9%) central, and two (0.4%) lateral recurrences were observed. Lateral recurrences occurred in the immediate completion N0 and Nx groups but not in the N1a observation arms. There were two (3.3%) central recurrences without thyroid or lateral recurrence on the observation arm of N1a observation patients. But two (1.1%) thyroid and three (1.7%) central recurrences were on the observation arm of N0 patients. In Kaplan-Meier survival curves for central or lateral recurrences between observation arms for the N1a and N0 groups, no significant difference was found between the N1a and N0 observation arms (P = 0.365).
CONCLUSION
The timing of when to perform completion thyroidectomy in central metastases-proven patients after lobectomy for PTC should be based on the patient's risk category.

Keyword

Observation; Lymphatic metastasis; Thyroid neoplasms; Thyroidectomy

MeSH Terms

Arm
Carcinoma, Papillary
Factor IX
Humans
Illegitimacy
Informed Consent
Kaplan-Meier Estimate
Lymphatic Metastasis
Neoplasm Metastasis
Recurrence
Retrospective Studies
Thyroid Gland
Thyroid Neoplasms
Thyroidectomy
Factor IX

Figure

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  Fig. 1 Follow-up of 522 patients underwent lobectomy due to papillary thyroid cancer. CLND, central lymph node dissection.

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  Fig. 2 Kaplan-Meier survival curves for central or lateral recurrences according to observation arm of N1a versus N0 groups (P = 0.365, log-rank test).

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