Int J Thyroidol.  2021 Nov;14(2):73-80. 10.11106/ijt.2021.14.2.73.

Thyroid Lobectomy as an Initial Treatment Option on 1-4 cm Papillary Cancer

• Cho JS

• KMID: 2522910
• DOI: http://doi.org/10.11106/ijt.2021.14.2.73

Abstract

Recently, the early diagnosis and treatment of differentiated thyroid cancer has significantly increased the proportion of thyroid lobectomy rather than total thyroidectomy. Thyroid lobectomy is recommended for less than 1 cm and total thyroidectomy for more than 4 cm except in unusual cases. There are still controversies in papillary cancer, which size from 1 to 4 cm. There are some reports that the indiscriminate expansion of thyroid lobectomy results in inferior results on the recurrence rate and survival rate compared to total thyroidectomy. But several other studies revealed that the recurrence after lobectomy could be diagnosed, it would not increase the rate of locoregional recurrence and mortality. It is necessary to make efforts to completely remove the cancer and lymph node metastasis, even in unilateral multiple papillary cancers, microscopic or gross invasion to the strap muscles (T3b), even in patients with lateral metastasis, or microscopic central lymph node metastasis. Although the proportion of these patients is nearly half of all 1-4 cm patients with papillary cancer, thyroid lobectomy may be considered as an alternative treatment to total thyroidectomy for patients with 1-4 cm papillary cancer.

Keyword

Thyroidectomy; Thyroid cancer; papillary; Thyroid neoplasms

Figure

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  Fig. 1 Trends of surgical extent of thyroidectomy in our institutions. The proportion of thyroid lobectomy (blue bar) gradually increased to 23% (2014) from 13% (2009). It came-from-behind the rate of total thyroidectomy (red bar) in 2015, and occupied of 57% on all thyroid surgeries in 2020.

Reference

References

1. Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee LS, et al. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. 2009; Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 19(11):1167–214. DOI: 10.1089/thy.2009.0110. PMID: 19860577.

2. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2016; 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 26(1):1–133. DOI: 10.1089/thy.2015.0020. PMID: 26462967. PMCID: PMC4739132.

3. Tuttle RM, Haugen B, Perrier ND. 2017; Updated American Joint Committee on cancer/tumor-node-metastasis staging system for differentiated and anaplastic thyroid cancer (eighth edition): what changed and why? Thyroid. 27(6):751–6. DOI: 10.1089/thy.2017.0102. PMID: 28463585. PMCID: PMC5467103.

4. Suman P, Razdan SN, Wang CE, Tulchinsky M, Ahmed L, Prinz RA, et al. 2020; Thyroid lobectomy for T1b-T2 papillary thyroid cancer with high-risk features. J Am Coll Surg. 230(1):136–44. DOI: 10.1016/j.jamcollsurg.2019.09.021. PMID: 31672668.

5. Bilimoria KY, Zanocco K, Sturgeon C. 2008; Impact of surgical treatment on outcomes for papillary thyroid cancer. Adv Surg. 42:1–12. DOI: 10.1016/j.yasu.2008.03.001. PMID: 18953806.

6. Clark RL Jr, White EC, Russell WO. 1959; Total thyroidectomy for cancer of the thyroid: significance of intraglandular dissemination. Ann Surg. 149(6):858–66. DOI: 10.1097/00000658-195906000-00009. PMID: 13650472. PMCID: PMC1451130.

7. Rose RG, Kelsey MP, Russell WO, Ibanez ML, White EC, Clark RL. 1963; Follow-up study of thyroid cancer treated by unilateral lobectomy. Am J Surg. 106:494–500. DOI: 10.1016/0002-9610(63)90136-3. PMID: 14062954.

8. Clark OH. 1982; Total thyroidectomy: the treatment of choice for patients with differentiated thyroid cancer. Ann Surg. 196(3):361–70. DOI: 10.1097/00000658-198209000-00016. PMID: 7114941. PMCID: PMC1352618.

9. Bilimoria KY, Bentrem DJ, Ko CY, Stewart AK, Winchester DP, Talamonti MS, et al. 2007; Extent of surgery affects survival for papillary thyroid cancer. Ann Surg. 246(3):375–81. discussion 81–4. DOI: 10.1097/SLA.0b013e31814697d9. PMID: 17717441. PMCID: PMC1959355.

10. Barney BM, Hitchcock YJ, Sharma P, Shrieve DC, Tward JD. 2011; Overall and cause-specific survival for patients undergoing lobectomy, near-total, or total thyroidectomy for differentiated thyroid cancer. Head Neck. 33(5):645–9. DOI: 10.1002/hed.21504. PMID: 20687168.

11. Machens A, Holzhausen HJ, Dralle H. 2005; The prognostic value of primary tumor size in papillary and follicular thyroid carcinoma. Cancer. 103(11):2269–73. DOI: 10.1002/cncr.21055. PMID: 15856429.

12. Hay ID, Grant CS, Bergstralh EJ, Thompson GB, van Heerden JA, Goellner JR. 1998; Unilateral total lobectomy: is it sufficient surgical treatment for patients with AMES low-risk papillary thyroid carcinoma? Surgery. 124(6):958–64. discussion 64–6. DOI: 10.1016/S0039-6060(98)70035-2. PMID: 9854569.

13. Wanebo H, Coburn M, Teates D, Cole B. 1998; Total thyroidectomy does not enhance disease control or survival even in high-risk patients with differentiated thyroid cancer. Ann Surg. 227(6):912–21. DOI: 10.1097/00000658-199806000-00015. PMID: 9637555. PMCID: PMC1191404.

14. Mendelsohn AH, Elashoff DA, Abemayor E, St John MA. 2010; Surgery for papillary thyroid carcinoma: is lobectomy enough? Arch Otolaryngol Head Neck Surg. 136(11):1055–61. DOI: 10.1001/archoto.2010.181. PMID: 21079156.

15. Song E, Han M, Oh HS, Kim WW, Jeon MJ, Lee YM, et al. 2019; Lobectomy is feasible for 1-4 cm papillary thyroid carcinomas: a 10-year propensity score matched-pair analysis on recurrence. Thyroid. 29(1):64–70. DOI: 10.1089/thy.2018.0554. PMID: 30375260.

16. Kebebew E, Duh QY, Clark OH. 2000; Total thyroidectomy or thyroid lobectomy in patients with low-risk differentiated thyroid cancer: surgical decision analysis of a controversy using a mathematical model. World J Surg. 24(11):1295–302. DOI: 10.1007/s002680010215. PMID: 11038197.

17. Albinsaad LS, Kim WW, Lee YM, Sung TY, Chung KW, Hong SJ. 2021; The appropriateness of thyroid lobectomy for preoperatively detected unilateral multifocal papillary carcinoma as initial surgery. Asian J Surg. 44(8):1050–55. DOI: 10.1016/j.asjsur.2021.01.004. PMID: 33573922.

18. Kim TH, Kim YN, Kim HI, Park SY, Choe JH, Kim JH, et al. 2017; Prognostic value of the eighth edition AJCC TNM classification for differentiated thyroid carcinoma. Oral Oncol. 71:81–6. DOI: 10.1016/j.oraloncology.2017.06.004. PMID: 28688696.

19. Tam S, Boonsripitayanon M, Amit M, Fellman BM, Li Y, Busaidy NL, et al. 2018; Survival in differentiated thyroid cancer: comparing the AJCC cancer staging seventh and eighth editions. Thyroid. 28(10):1301–10. DOI: 10.1089/thy.2017.0572. PMID: 30141373.

20. Park SY, Kim HI, Kim JH, Kim JS, Oh YL, Kim SW, et al. 2018; Prognostic significance of gross extrathyroidal extension invading only strap muscles in differentiated thyroid carcinoma. Br J Surg. 105(9):1155–62. DOI: 10.1002/bjs.10830. PMID: 29663333.

21. Nishino M, Jacob J. 2020; Invasion in thyroid cancer: controversies and best practices. Semin Diagn Pathol. 37(5):219–27. DOI: 10.1053/j.semdp.2020.02.003. PMID: 32173146.

22. Yoon JK, Lee J, Kim EK, Yoon JH, Park VY, Han K, et al. 2020; Strap muscle invasion in differentiated thyroid cancer does not impact disease-specific survival: a population-based study. Sci Rep. 10(1):18248. DOI: 10.1038/s41598-020-75161-y. PMID: 33106498. PMCID: PMC7589560.

23. Urken ML. Management of well-differentiated thyroid cancer in 2010: perspectives of a head and neck surgical oncologist. Endocr Pract. 2010; 16(5):903–12. DOI: 10.4158/EP10133.RA. PMID: 20713343.

24. National Comprehensive Cancer Network (2020). 2020. Thyroid (Version 3.2020). Retrieved from [cited June 22, 2021]. Available from: https://www.nccn.org/professionals/physician_gls/pdf/thyroid.pdf.

25. Fujiwara T, Yoshizawa A, Mizuta M, Tamaki H. 2021; Is surgical resection without radioactive iodine treatment a safe alternative treatment for T1-2N1bM0 papillary thyroid carcinoma? Auris Nasus Larynx. 48(1):148–53. DOI: 10.1016/j.anl.2020.07.005. PMID: 32718811.

26. Kluijfhout WP, Pasternak JD, Lim J, Kwon JS, Vriens MR, Clark OH, et al. 2016; Frequency of high-risk characteristics requiring total thyroidectomy for 1-4 cm well-differentiated thyroid cancer. Thyroid. 26(6):820–4. DOI: 10.1089/thy.2015.0495. PMID: 27083216.

27. Kim WW. 2020; Optimal extent of surgery for papillary thyroid carcinoma. Int J Thyroidol. 13(2):72–8. DOI: 10.11106/ijt.2020.13.2.72.