Skip to main content

Advertisement

Log in

Excellent Prognosis of Patients with Solitary T1N0M0 Papillary Thyroid Carcinoma Who Underwent Thyroidectomy and Elective Lymph Node Dissection Without Radioiodine Therapy

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

The extent of surgery for papillary carcinoma significantly differs between western countries and Japan. Almost routine total thyroidectomy with radioiodine ablation therapy has been performed in western countries, whereas limited thyroidectomy has been adopted in Japan, especially for low-risk cases. In this study, the prognosis of patients with solitary papillary carcinoma measuring 2 cm or less without massive extrathyroid extension, clinically apparent lymph node metastasis or distant metastasis at diagnosis (T1N0M0 in the UICC TNM classification) was investigated to elucidate the appropriate extent of surgery for these patients.

Methods

We investigated the prognosis of 2,638 patients with solitary T1N0M0 papillary carcinoma who underwent initial surgery between 1987 and 2004. Total or near total thyroidectomy was performed for 1,037 patients and the remaining 1,601 patients underwent more limited thyroidectomy. Elective central node dissection was performed for 2,511 patients, accounting for 96%, and 1,545 (59%) also underwent prophylactic lateral node dissection. Radioiodine ablation therapy was performed only for three patients.

Results

The 10-year disease-free survival (DFS) rate of our series was 97%. To date, recurrence was observed in 62 patients (2%) and 41 showed recurrence to the regional lymph nodes. Seventeen of 1,601 patients who received limited thyroidectomy (1%) showed recurrence to the remnant thyroid. Pathological nodal-positive patients showed a worse DFS, but the 10-year DFS rate was still high at 96%. Patients with total or near total thyroidectomy had a better DFS, but the difference disappeared if recurrence to the remnant thyroid was excluded. A number needed to treat (NNT) for total or near total thyroidectomy over hemithyroidectomy was 83 to prevent 1 recurrence.

Conclusions

These findings suggest that solitary T1N0M0 patients have an excellent prognosis when they undergo thyroidectomy and elective lymph node dissection without radioiodine therapy. Regarding the extent of thyroidectomy, hemithyroidectomy is adequate for these patients, if a 1% risk of recurrence to the remnant thyroid is accepted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ito Y, Tomoda C, Uruno T et al (2005) Ultrasound-detectable and anatomopathologically detectable node metastasis in the lateral compartment as indicators of worse relapse-free survival in patients with papillary thyroid carcinoma. World J Surg 29:917–920

    Article  PubMed  Google Scholar 

  2. Ito Y, Tomoda C, Uruno T et al (2006) Prognostic significance of extrathyroid extension of papillary thyroid carcinoma: massive but not minimal extension affects the relapse-free survival. World J Surg 30:780–786

    Article  PubMed  Google Scholar 

  3. Ito Y, Miyauchi A, Jikuzono T et al (2007) Risk factors contributing to a poor prognosis of papillary thyroid carcinoma. Validity of UICC/AJCC TNM classification and stage grouping. World J Surg 31:838–848

    Article  PubMed  Google Scholar 

  4. Ito Y, Kakudo K, Hirokawa M et al (2009) Biological behavior and prognosis of familial papillary thyroid carcinoma. Surgery 145:100–105

    Article  PubMed  Google Scholar 

  5. Ito Y, Miyauchi A (2009) Prognostic factors and therapeutic strategies for differentiated carcinoma of the thyroid. Endocrine J 56:177–192

    Article  Google Scholar 

  6. Mazzaferri EL, Kloos RT (2001) Current approaches to primary therapy for papillary and follicular thyroid cancer. J Clin Endocrinol Metab 86:1447–1463

    Article  CAS  PubMed  Google Scholar 

  7. Hay ID, Grant CS, Bergstralh EJ, Thompson GB, van Heerden JA (1998) Unilateral total lobectomy: is it sufficient surgical treatment for patients with MES low-risk papillary thyroid carcinoma? Surgery 124:658–966

    Google Scholar 

  8. Hay ID, Hutchinson ME, Gonzalez-Losada T et al (2008) Papillary thyroid microcarcinoma: a study of 900 cases observed in a 60-year period. Surgery 144:980–988

    Article  PubMed  Google Scholar 

  9. DeGroot LJ, Kaplan EL, McCormick M, Straus FH (1990) Natural history, treatment, and course of papillary thyroid carcinoma. J Clin Endocrinol Metab 71:414–424

    Article  CAS  PubMed  Google Scholar 

  10. Sobin LH, Ch Wittekind (eds) (2002) UICC: TNM classification of malignant tumors, 6th edn. Wiley-Liss, New York

    Google Scholar 

  11. Antonelli A, Miccoli P, Ferdeghini M (1995) Role of neck ultrasonography in follow-up of patients operated on for differentiated thyroid cancer. Thyroid 5:25–29

    Article  CAS  PubMed  Google Scholar 

  12. Uruno T, Miyauchi A, Shimizu K et al (2005) Usefulness of thyroglobulin measurement in fine-needle aspiration biopsy specimens for diagnosing cervical lymph node metastasis in patients with papillary thyroid cancer. World J Surg 29:483–485

    Article  PubMed  Google Scholar 

  13. DeGroot LJ, Kaplan EL, Straus FH, Shukla MS (1994) Does the method of management of papillary thyroid carcinoma make a difference in outcome? World J Surg 18:123–130

    Article  CAS  PubMed  Google Scholar 

  14. Ito Y, Uruno R, Nakano K et al (2003) An observation trial without surgical treatment in patients with papillary microcarcinoma of the thyroid. Thyroid 13:381–388

    Article  PubMed  Google Scholar 

  15. Ito Y, Tomoda C, Uruno T et al (2004) Papillary microcarcinoma of the thyroid: how should it be treated? World J Surg 28:1115–1121

    Article  PubMed  Google Scholar 

  16. Dralle H, Gimm O (1996) Lymphadenektomie beim schilddrusencarcinom [in German]. Chirurg 67:788–806

    Article  CAS  PubMed  Google Scholar 

  17. Martenson H, Terins J (1985) Recurrent laryngeal nerve palsy in thyroid gland surgery related to operations and nerves at risk. Arch Surg 120:475–482

    Google Scholar 

  18. Scheumann GF, Seeliger H, Musholt TF et al (1996) Completion thyroidectomy in 131 patients with differentiated thyroid carcinoma. Eur J Surg 162:677–684

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yasuhiro Ito.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ito, Y., Masuoka, H., Fukushima, M. et al. Excellent Prognosis of Patients with Solitary T1N0M0 Papillary Thyroid Carcinoma Who Underwent Thyroidectomy and Elective Lymph Node Dissection Without Radioiodine Therapy. World J Surg 34, 1285–1290 (2010). https://doi.org/10.1007/s00268-009-0356-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-009-0356-0

Keywords

Navigation