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Long-Term Outcomes After Lobectomy for Patients with High-Risk Papillary Thyroid Carcinoma

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Abstract

Background

Guidelines universally recommend total thyroidectomy for high-risk papillary thyroid carcinoma (PTC). However, in Japan, thyroid-conserving surgery had been widely applied for such patients until recently. We investigated long-term outcomes for this strategy.

Methods

A prospectively recorded database was retrospectively analyzed for 368 patients who had undergone curative surgery for high-risk PTC without distant metastasis between 1993 and 2013. High-risk PTC was defined for tumors showing tumor size > 4 cm, extrathyroidal extension, or large nodal metastasis ≥ 3 cm.

Results

Median age was 59 years and 243 patients were female. Mean duration of follow-up was 12.7 years. Lobectomy was conducted for 207 patients (LT group) and total or near-total thyroidectomy for 161 patients (TT group). The frequency of massive extrathyroidal invasion and large nodal metastasis was lower in the LT group than in the TT group. After propensity score matching, no significant differences were seen between groups for overall survival, cause-specific survival or distant recurrence-free survival. In the overall cohort, multivariate analysis identified age ≥ 55 years, large nodal metastasis, tumor size > 4 cm and massive extrathyroidal invasion as significantly associated with cause-specific survival, whereas extent of thyroidectomy was not.

Conclusions

For patients with high-risk PTC without distant metastasis, curative surgery with lobectomy showed almost identical oncological outcomes compared to total thyroidectomy. The benefits of total thyroidectomy for high-risk PTC should be reevaluated in the future prospective studies.

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Abbreviations

PTC:

Papillary thyroid carcinoma

RAI:

Radioactive iodine

TSH:

Thyroid-stimulating hormone

JAES:

Japan association of endocrine surgery

CIH:

Cancer institute hospital

LT group:

Lobectomy group

TT group:

Total or near-total thyroidectomy group

CT:

Computed tomography

OS:

Overall survival

CSS:

Cause-specific survival

MRFS:

Distant recurrence-free survival

QOL:

Quality of life

DTC:

Differentiated thyroid carcinoma

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Acknowledgements

We wish to acknowledge and thank Dr. Toshiaki Otsuka from the Department of Hygiene and Public Health, Nippon Medical School, Tokyo, Japan, for assistance with statistical analysis.

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Authors and Affiliations

  1. Department of Endocrine Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Iwao Sugitani, Hiroko Kazusaka & Aya Ebina

  2. Division of Head and Neck, Cancer Institute Hospital, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Iwao Sugitani, Wataru Shimbashi & Kazuhisa Toda

  3. Pathology Project for Molecular Targets, The Cancer Institute, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Kengo Takeuchi

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  1. Iwao Sugitani
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Contributions

Study concept, design, interpretation and writing, IS; statistical data analysis, IS and HK; acquisition of the data, IS, AE, WS, KT; methodology, investigation and validation for molecular marker analysis, KT and AE; funding acquisition, IS. All authors contributed to drafting of the manuscript and critical revisions and agreed to publication of the submitted version of the manuscript.

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Correspondence to Iwao Sugitani.

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The authors declare that they have no conflict of interest.

Ethical approval

The institutional review board of Cancer Institute Hospital approved the study protocol (IRB number 2013–1128, 24 January 2014). All subjects gave their informed consent for inclusion before they participated in the study.

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Sugitani, I., Kazusaka, H., Ebina, A. et al. Long-Term Outcomes After Lobectomy for Patients with High-Risk Papillary Thyroid Carcinoma. World J Surg 47, 382–391 (2023). https://doi.org/10.1007/s00268-022-06705-8

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