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Extent of surgery affects survival for papillary thyroid cancer Bilimoria KY; Bentrem DJ; Ko CY; Stewart AK; Winchester DP; Talamonti MS; Sturgeon CAnn Surg 2007[Sep]; 246 (3): 375-81; discussion 381-4BACKGROUND: The extent of surgery for papillary thyroid cancers (PTC) remains controversial. Consensus guidelines have recommended total thyroidectomy for PTC > or =1 cm; however, no study has supported this recommendation based on a survival advantage. The objective of this study was to examine whether the extent of surgery affects outcomes for PTC and to determine whether a size threshold could be identified above which total thyroidectomy is associated with improved outcomes. METHODS: From the National Cancer Data Base (1985-1998), 52,173 patients underwent surgery for PTC. Survival was estimated by the Kaplan-Meier method and compared using log-rank tests. Cox Proportional Hazards modeling stratified by tumor size was used to assess the impact of surgical extent on outcomes and to identify a tumor size threshold above which total thyroidectomy is associated with an improvement in recurrence and long-term survival rates. RESULTS: Of the 52,173 patients, 43,227 (82.9%) underwent total thyroidectomy, and 8946 (17.1%) underwent lobectomy. For PTC <1 cm extent of surgery did not impact recurrence or survival (P = 0.24, P = 0.83). For tumors > or =1 cm, lobectomy resulted in higher risk of recurrence and death (P = 0.04, P = 0.009). To minimize the influence of larger tumors, 1 to 2 cm lesions were examined separately: lobectomy again resulted in a higher risk of recurrence and death (P = 0.04, P = 0.04). CONCLUSIONS: The results of this study demonstrate that total thyroidectomy results in lower recurrence rates and improved survival for PTC > or =1.0 cm compared with lobectomy. This is the first study to demonstrate that total thyroidectomy for PTC > or =1.0 cm improves outcomes.|Adolescent[MESH]|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Carcinoma, Papillary/mortality/pathology/*surgery[MESH]|Female[MESH]|Humans[MESH]|Male[MESH]|Middle Aged[MESH]|Neoplasm Recurrence, Local[MESH]|Neoplasm Staging[MESH]|Prognosis[MESH]|Risk Factors[MESH]|Survival Rate[MESH]|Thyroid Neoplasms/mortality/pathology/*surgery[MESH]|Thyroidectomy/*methods[MESH]|Treatment Outcome[MESH] |
