Significance of Surgery Options for Papillary Thyroid Cancer

Extent of Surgery Affects Survival for Papillary Thyroid Cancer is a paper published in the Annals of Surgery. It is authored by Karl Y. Bilimoria, MD, David J. Bentrem, MD, Clifford Y. Ko, MD, MS, MSHS, Andrew K. Stewart, MA, David P. Winchester, MD, Mark S. Talamonti, MD, and Cord Sturgeon, MD, MS. The paper takes note of the encouraging fact that papillary thyroid cancer is the most common but, at the same time, least aggressive form of thyroid cancer. An excellent prognosis is the norm for PTC.

But the paper also notes a controversy that has centered on surgical options with respect to tumors that are less than 4 centimeters in diameter. It is this controversy about which the referenced study is concerned namely, which of the surgical options is optimal. The study focused on the hypothesis that total thyroidectomy yields improved outcomes compared with lobectomy. 52,173 patients, who underwent surgery for PTC from 1985 to 1998, were the basis for the data generated. The study sought to answer the question of whether total thyroidectomy improved long-term survival rates for PTC patients. Also targeted was the issue of whether total thyroidectomy was associated with a decreased risk of death for tumor sizes exceeding a specified threshold.

The paper noted that, for the sizable group studied, lobectomy procedures on tumors, that were equal to or greater than one centimeter, resulted in a higher risk of death. For tumors smaller than one centimeter the difference between lobectomy and total thyroidectomy with respect to survival was not statistically significant. Note the conclusion in the words of the authors:

The results of this study demonstrate that total thyroidectomy results in lower recurrence rates and improved survival for PTC ≥1.0 cm compared with lobectomy. This is the first study to demonstrate that total thyroidectomy for PTC ≥1.0 cm improves outcomes.