Papillary thyroid cancer surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2] Ammu Susheela, M.D. [3]

Overview

Surgery is the mainstay of treatment for papillary thyroid cancer. Surgical interventions of papillary thyroid cancer include total thyroidectomy and lobectomy. Each of these has its indications.

Surgery

Surgery remains the mainstay of treatment for papillary thyroid cancer.^[1]^[2]^[3]^[4]
Surgical interventions of papillary thyroid cancer include total thyroidectomy and lobectomy. Each of these has its indications.

indications

Total thyroidectomy is usually reserved for patients with either:^[1]^[2]^[3]^[4]
- Known distant metastasis
- Extra-thyroidal extension
- Tumor> 4 cm in diameter
- Cervical lymph node metastasis
- Poorly differentiated tumor
- In case of bilateral nodularity
- Prior radiation exposure
Total thyroidectomy or lobectomy is indicated if all of these criteria are present:
- No prior radiation exposure
- No distant metastasis
- No cervical lymph node metastasis
- No extra-thyroidal extension
- Tumor≤ 4 cm
Lobectomy is considered curative if all of the following are present:
- Negative resection margins
- No contralateral lesion
- No suspicious lymph nodes
- Small tumors (< 1 cm) found incidentally on the final pathology sections
Lobectomy plus isthmusectomy is recommended for patients who are not willing to take thyroxine replacement therapy for the rest of their lives.
Total thyroidectomy should be performed after lobectomy plus isthmusectomy if either of these criteria is present:
- Large tumor (> 4 cm)
- Positive resection margins
- Gross extra-thyroidal extension
- Macroscopic multi-focal disease
- Vascular invasion
- Macroscopic nodal metastasis

References

↑ ^1.0 ^1.1 “NCCN Clinical Practice Guidelines in Oncology”.
↑ ^2.0 ^2.1 Bilimoria KY, Zanocco K, Sturgeon C (2008). “Impact of surgical treatment on outcomes for papillary thyroid cancer”. Adv Surg. 42: 1–12. PMID 18953806.
↑ ^3.0 ^3.1 Stack BC, Ferris RL, Goldenberg D, Haymart M, Shaha A, Sheth S, Sosa JA, Tufano RP (May 2012). “American Thyroid Association consensus review and statement regarding the anatomy, terminology, and rationale for lateral neck dissection in differentiated thyroid cancer”. Thyroid. 22 (5): 501–8. doi:10.1089/thy.2011.0312. PMID 22435914.
↑ ^4.0 ^4.1 Viola D, Materazzi G, Valerio L, Molinaro E, Agate L, Faviana P, Seccia V, Sensi E, Romei C, Piaggi P, Torregrossa L, Sellari-Franceschini S, Basolo F, Vitti P, Elisei R, Miccoli P (April 2015). “Prophylactic central compartment lymph node dissection in papillary thyroid carcinoma: clinical implications derived from the first prospective randomized controlled single institution study”. J. Clin. Endocrinol. Metab. 100 (4): 1316–24. doi:10.1210/jc.2014-3825. PMID 25590215.

Overview