Papillary thyroid cancer surgery
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Papillary thyroid cancer Microchapters |
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Differentiating Papillary thyroid cancer from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Papillary thyroid cancer surgery On the Web |
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American Roentgen Ray Society Images of Papillary thyroid cancer surgery |
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Risk calculators and risk factors for Papillary thyroid cancer surgery |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]
Overview
Surgery
Surgery remains the mainstay of treatment for papillary thyroid cancer. The Revised 2009 American Thyroid Association guidelines for papillary thyroid cancer state that the initial procedure should be near-total or total thyroidectomy. Thyroid lobectomy alone may be sufficient treatment for small (<1cm), low-risk, unifocal, intrathyroidal papillary carcinomas in the absence of prior head and neck irradiation or radiologically or clinically involved cervical nodal metastasis.[1]
- Minimal disease (diameter up to 1.0 centimeters) - hemithyroidectomy (or unilateral lobectomy) and isthmectomy may be sufficient. There is some discussion whether this is still preferable over total thyroidectomy for this group of patients.
- Gross disease (diameter over 1.0 centimeters) - total thyroidectomy, and central compartment lymph node removal is the therapy of choice. Additional lateral neck nodes can be removed at the same time if an ultrasound guided FNA and thyrobulin TG cancer washing was positive on the pre-operative neck node ultrasound evaluation.
Arguments for total thyroidectomy are:[2]
- Reduced risk of recurrence, if central compartment nodes are removed at the original surgery.
- 30-85% of papillary carcinoma is multifocal disease. Hemithyroidectomy may leave disease in the other lobe. However, multifocal disease in the remnant lobe may not necessarily become clinically significant or serve as detriment to patient survival.
- Ease of monitoring with thyroglobulin (sensitivity for picking up recurrence is increased in presence of total thyroidectomy, and ablation of remnant normal thyroid by low dose radioiodine 131 after following a low iodine diet (LID).
- Ease of detection of metastatic disease by thyroid and neck node ultrasound.
- Post-operative complications at high-volume thyroid surgery centers with experienced surgeons are comparable to that of hemithyroidectomy.
Arguments for hemithyroidectomy:
- Most patients have low-risk cancer with excellent prognosis, with similar survival outcomes in low-risk patients who undergo total thyroidectomy versus hemithyroidectomy.
- Less likelihood of patient requiring lifelong thyroid hormone replacement after surgery.
Indications
Contraindications
References
- ↑ Cooper, David (November 2009). "Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer". Thyroid.
- ↑ Udelsman, Robert (July 2005). "Is total thyroidectomy the best possible surgical management for well-differentiated thyroid cancer?". The Lancet Oncology.