Kim Seo Ki, Park Inhye, Woo Jung-Woo, Lee Jun Ho, Choe Jun-Ho, Kim Jung-Han, Kim Jee Soo
Division of Breast and Endocrine Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Surgery, Changwon Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Changwon, South Korea.
Surgery. 2017 Feb;161(2):485-492. doi: 10.1016/j.surg.2016.07.037. Epub 2016 Sep 1.
Because there is a controversy regarding the management of papillary thyroid microcarcinoma, the purpose of this study was to compare lobectomy with total thyroidectomy as a primary operative treatment for papillary thyroid microcarcinoma. Loco-regional recurrence in the contralateral remnant lobe can be managed safely by completion thyroidectomy via the previous scar. However, reoperation for operation bed (thyroidectomy site) or regional lymph node (central or lateral) recurrence generally is associated with morbidity. Therefore, we analyzed overall loco-regional recurrence and loco-regional recurrence outside of the contralateral remnant lobe separately.
We retrospectively reviewed 8,676 conventional patients with papillary thyroid microcarcinoma who underwent thyroidectomy.
Lobectomy was performed in 3,289 (37.9%) patients, and total thyroidectomy was performed in 5,387 (62.1%) patients. Total thyroidectomy significantly decreased the risk of overall loco-regional recurrence (adjusted hazard ratio 0.398, P < .001). However, total thyroidectomy did not significantly decrease the risk of loco-regional recurrence outside of the contralateral remnant lobe (adjusted hazard ratio 0.880, P = .640). Particularly in conventional papillary thyroid microcarcinoma patients with multifocality, total thyroidectomy significantly decreased the risk of overall loco-regional recurrence (adjusted hazard ratio 0.284, P = .002) and loco-regional recurrence outside of the contralateral remnant lobe (adjusted hazard ratio 0.342, P = .020).
Although lobectomy is associated with contralateral remnant lobe recurrence, lobectomy did not increase the risk of loco-regional recurrence outside of the contralateral remnant lobe in patients with papillary thyroid microcarcinoma, except in those with multifocality. Because recurrence in the contralateral remnant lobe can be managed safely by completion thyroidectomy, lobectomy may be a safe operative option for select patients with papillary thyroid microcarcinoma without multifocality.
由于甲状腺微小乳头状癌的治疗存在争议，本研究旨在比较甲状腺叶切除术与甲状腺全切除术作为甲状腺微小乳头状癌的主要手术治疗方法。通过原手术瘢痕行甲状腺全切除术可安全处理对侧残余叶的局部区域复发。然而，针对手术床（甲状腺切除部位）或区域淋巴结（中央或侧方）复发的再次手术通常会伴有并发症。因此，我们分别分析了总体局部区域复发以及对侧残余叶以外的局部区域复发情况。
我们回顾性分析了8676例行甲状腺切除术的常规甲状腺微小乳头状癌患者。
3289例（37.9%）患者行甲状腺叶切除术，5387例（62.1%）患者行甲状腺全切除术。甲状腺全切除术显著降低了总体局部区域复发风险（调整后风险比0.398，P <.001）。然而，甲状腺全切除术并未显著降低对侧残余叶以外的局部区域复发风险（调整后风险比0.880，P =.640）。特别是在有多灶性的常规甲状腺微小乳头状癌患者中，甲状腺全切除术显著降低了总体局部区域复发风险（调整后风险比0.284，P =.002）以及对侧残余叶以外的局部区域复发风险（调整后风险比0.342，P =.020）。
尽管甲状腺叶切除术与对侧残余叶复发相关，但在甲状腺微小乳头状癌患者中，除多灶性患者外，甲状腺叶切除术并未增加对侧残余叶以外的局部区域复发风险。由于对侧残余叶的复发可通过甲状腺全切除术安全处理，对于部分无多灶性的甲状腺微小乳头状癌患者，甲状腺叶切除术可能是一种安全的手术选择。
