Park Hakyoung, Harries Victoria, McGill Marlena R, Ganly Ian, Shah Jatin P
Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Surgery, InJe University Busan Paik Hospital, Busan, South Korea.
Head Neck. 2020 Jan;42(1):43-49. doi: 10.1002/hed.25968. Epub 2019 Oct 7.
Isthmusectomy in the treatment of well-differentiated thyroid carcinoma (WDTC) is controversial. In this study, we analyze the outcomes of WDTC managed by isthmusectomy alone.
Forty-three patients treated with isthmusectomy alone were identified from an institutional database of 6259 surgically treated patients with WDTC. Patient and tumor characteristics were analyzed. Disease-specific survival (DSS) and recurrence-free survival (RFS) were calculated using the Kaplan-Meier method.
The pT classification was T1 for 41 and T2 for two patients. All were clinical N0, but 10 pts were pN1a. Using the American Thyroid Association risk stratification system, 9 patients were low-risk and 22 were intermediate-risk. One patient developed local recurrence, and two developed regional lymph node metastases; the 5- and 10-year DSS was 100.0%. The 5- and 10-year RFS was 93.1%.
Isthmusectomy alone is an acceptable procedure in selected patients with low- and intermediate-risk WDTC limited to the isthmus.
峡部切除术治疗分化型甲状腺癌（WDTC）存在争议。在本研究中，我们分析了仅接受峡部切除术治疗的WDTC患者的预后。
从一个包含6259例接受手术治疗的WDTC患者的机构数据库中，确定了43例仅接受峡部切除术治疗的患者。分析了患者和肿瘤特征。采用Kaplan-Meier法计算疾病特异性生存率（DSS）和无复发生存率（RFS）。
41例患者的pT分期为T1，2例为T2。所有患者临床均为N0，但10例患者为pN1a。根据美国甲状腺协会风险分层系统，9例患者为低风险，22例为中风险。1例患者发生局部复发，2例发生区域淋巴结转移；5年和10年DSS为100.0%。5年和10年RFS为93.1%。
对于局限于峡部的低风险和中风险WDTC患者，仅行峡部切除术是一种可接受的手术方式。
