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Surgical management of papillary thyroid carcinoma in childhood and adolescence: an Italian multicenter study on 250 patients

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Abstract

Purpose

The extent of surgery for pediatric papillary thyroid carcinoma is debatable. The aim of this study was to evaluate the feasibility of offering pediatric patients a tailored surgical approach based on certain clinical features.

Methods

A national multicenter retrospective review of 250 pediatric patients treated for papillary thyroid carcinoma in a 14-year period was performed. Outcomes of interest included tumor-related features, type of surgery, surgical morbidity, disease-free and overall survival rates. Recurrence was thoroughly analyzed with particular focus on how it correlated with certain patient- and tumor-related features.

Results

The majority of patients (58.8 %) had tumors >2 cm in size. Nodal involvement occurred in 115/250 (46 %) patients and distant metastasis in 4 % (10/250). Total thyroidectomy and lobectomy were performed in 90.4 % (226/250) and 9.6 % (24/250) of patients, respectively. The overall rate of surgical complications was 20.8 % (52/250). These included transient and permanent hypoparathyroidism (13.6 and 4.4 %, respectively), and vocal fold palsy (2.8 %). All surgical complications occurred exclusively in the total thyroidectomy group. The rate of recurrent disease was 12 % (30/250) with the vast majority of recurrences (96.6 %) occurring in the total thyroidectomy group. The risk of recurrence correlated significantly with certain tumor-related features (size > 2 cm, multifocality, extrathyroidal invasion, nodal positivity, and distant metastasis). However, it did not correlate with the patient’s age or sex. Overall survival was 100 %.

Conclusion

Pediatric patients are likely to benefit from a tailored surgical strategy. Uniformly offering patients total thyroidectomy seems to be an overly radical approach.

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Abbreviations

PTC:

Papillary thyroid carcinoma

AJCC:

American Joint Committee on Cancer

US:

Ultrasound

FNAC:

Fine-needle aspiration with cytopathologic analysis

CT:

Computed tomography

MRI:

Magnetic resonance imaging

TSH:

Thyrotropin

RAI:

Radioactive iodine

MIVAT:

Minimally invasive video-assisted thyroidectomy

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Authors and Affiliations

  1. Division of Surgery, Department of Surgical Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy

    C. Spinelli, S. Strambi, L. Rossi, S. Bakkar & P. Miccoli

  2. Pediatric Oncology Unit, Istituto Nazionale Tumori, University of Milan, Milan, Italy

    M. Massimino & A. Ferrari

  3. Department of Diagnostic Pathology and Laboratory Medicine, Istituto Nazionale Tumori, University of Milan, Milan, Italy

    P. Collini

  4. Department of Women’s and Children’s Health, Pediatric Surgery Unit, University Hospital of Padua, Padua, Italy

    G. Cecchetto

  5. Hematology-Oncology Division, Department of Pediatrics, Padova University Hospital of Padua, Padua, Italy

    G. Bisogno

  6. Division of Pediatric Surgery, Bambino Gesù Children’s Hospital, Rome, Italy

    A. Inserra

  7. Faculty of Mathematical, Physical and Natural Sciences, University of Pisa, Pisa, Italy

    F. Bianco

Authors
  1. C. Spinelli
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  2. S. Strambi
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  3. L. Rossi
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  4. S. Bakkar
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  5. M. Massimino
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  6. A. Ferrari
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  7. P. Collini
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  8. G. Cecchetto
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  9. G. Bisogno
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  10. A. Inserra
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  11. F. Bianco
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  12. P. Miccoli
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Corresponding author

Correspondence to C. Spinelli.

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Conflict of interest

The authors have no financial ties or conflicts of interest to disclose.

Ethical approval

The study was conducted in accordance with compliance with ethical guidelines.

Informed consent

This study was conducted after obtaining the informed consent from patients and/or their families.

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Spinelli, C., Strambi, S., Rossi, L. et al. Surgical management of papillary thyroid carcinoma in childhood and adolescence: an Italian multicenter study on 250 patients. J Endocrinol Invest 39, 1055–1059 (2016). https://doi.org/10.1007/s40618-016-0474-0

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  • DOI: https://doi.org/10.1007/s40618-016-0474-0

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