Department of Surgery, College of Medicine, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Surgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea.
Ann Surg Oncol. 2021 Oct;28(11):6603-6612. doi: 10.1245/s10434-021-09833-y. Epub 2021 Mar 25.
The treatment for papillary thyroid cancer (PTC) has become more conservative, but still no specific guidelines exist for managing isthmic PTC. This study analyzed the outcomes from isthmusectomy in single isthmic PTC and compared it with those for patients who previously had undergone a total thyroidectomy.
An isthmusectomy with prophylactic central compartment neck dissection (pCCND) was planned for a single isthmic PTC between 2014 and 2018 (isthmusectomy group). For cases with gross extrathyroidal extension (ETE) or multiple nodal metastasis, the procedure was converted to a total thyroidectomy. The study analyzed the characteristics and outcomes of the isthmusectomy group. Additionally, the results were compared with those of the isthmusectomy-feasible group who met the eligibility criteria for isthmusectomy among total thyroidectomies performed between 2009 and 2013.
Of the 90 patients in the isthmusectomy group, 81 received isthmusectomy and 9 had conversion to a total thyroidectomy. Microcarcinoma occurred in 72 cases and gross ETE in 3 cases. One patient showed occult satellite cancer, and seven patients showed more than five metastatic nodes. Transient hypocalcemia developed in five and patients and permanent hypocalcemia in one patient with total thyroidectomy. Of 46 patients who began hormone replacement postoperatively, 13 completely stopped taking medication during the follow-up period. Metachronous PTC was diagnosed for one patient 12 months after isthmusectomy. The isthmusectomy group and the isthmusectomy-feasible group showed similar clinicopathologic properties including multifocality, ETE, and nodal metastasis. However, the isthmusectomy group showed significantly less transient or permanent hypocalcemia and thyroid hormone dependency.
Isthmusectomy with pCCND may be a feasible alternative for properly selected isthmic PTC, resulting in a better quality of life than total thyroidectomy.
甲状腺乳头状癌（PTC）的治疗方法已变得更加保守，但目前仍没有针对峡部 PTC 管理的具体指南。本研究分析了单发峡部 PTC 行峡部切除术的结果，并与之前行甲状腺全切除术的患者进行了比较。
2014 年至 2018 年期间，计划对单发峡部 PTC 行峡部切除术加预防性中央区颈部淋巴结清扫术（pCCND）（峡部切除术组）。对于有明显甲状腺外侵犯（ETE）或多个淋巴结转移的病例，手术方式转换为甲状腺全切除术。本研究分析了峡部切除术组的特征和结果。此外，还将其结果与 2009 年至 2013 年期间行甲状腺全切除术且符合峡部切除术条件的峡部切除术可行组进行了比较。
峡部切除术组 90 例患者中，81 例行峡部切除术，9 例改行甲状腺全切除术。72 例为微小型癌，3 例为明显 ETE。1 例为隐匿性卫星癌，7 例为转移淋巴结>5 个。5 例发生一过性低钙血症，1 例行甲状腺全切除术患者发生永久性低钙血症。46 例术后开始激素替代治疗的患者中，13 例在随访期间完全停止服药。1 例患者在峡部切除术后 12 个月诊断为甲状腺癌。峡部切除术组和峡部切除术可行组的临床病理特征相似，包括多灶性、ETE 和淋巴结转移。然而，峡部切除术组的一过性或永久性低钙血症及甲状腺激素依赖发生率明显更低。
对于适当选择的峡部 PTC，行峡部切除术加 pCCND 可能是一种可行的替代方法，可改善生活质量，优于甲状腺全切除术。
