Li Danxia, Zhang Guojun, Li Xinna, Xu Shuo, Sun Haiqing, Liu Yang, Wu Guochang, Zheng Haitao, Zhang Xiaoli, Zheng Guibin
Department of Thyroid Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China.
Department of Breast and Thyroid Surgery, Changle People's Hospital, Weifang, China.
Ann Surg Oncol. 2025 Apr;32(4):2344-2352. doi: 10.1245/s10434-024-16643-5. Epub 2024 Dec 7.
Total thyroidectomy (TT) is usually recommended for unilateral papillary thyroid cancer (PTC) with lateral lymph node metastasis (LLNM), but no significant improvement in recurrence-free survival (RFS) is seen upon treatment. As an initial surgery, lobectomy may have advantages in appropriately selected unilateral PTC with ipsilateral LLNM.
This study aimed to explore the feasibility of lobectomy for selected unilateral PTC with ipsilateral LLNM.
From January 2014 to December 2021, we retrospectively reviewed patients with PTC and LLNM who were treated at our center. Patients preoperatively diagnosed with unilateral PTC and ipsilateral LLNM were recruited. Overall, 102 patients who chose lobectomy as their initial surgery were included in the lobectomy group and 96 patients who chose TT were included in the control group, defined as the TT group.
The mean follow-up time of the lobectomy group was 47.5 ± 22.2 months. Patients in the lobectomy group had a significantly lower rate of hypoparathyroidism than those in the TT group (0% vs. 11.5%; p < 0.001). RFS after lobectomy was comparable with that after TT according to Kaplan-Meier curve analysis (log-rank p = 0.80). Lobectomy achieved a significantly lower incidence of unsatisfactory TSH control than TT (5.9% vs. 20.8%; p = 0.006).
Lobectomy may be an appropriate initial therapy for selected unilateral PTC with ipsilateral LLNM. A randomized prospective study with long-term follow-up is warranted.
对于伴有侧方淋巴结转移（LLNM）的单侧甲状腺乳头状癌（PTC），通常建议行全甲状腺切除术（TT），但治疗后无病生存率（RFS）并无显著改善。作为初始手术，对于适当选择的伴有同侧LLNM的单侧PTC，甲状腺叶切除术可能具有优势。
本研究旨在探讨对选定的伴有同侧LLNM的单侧PTC行甲状腺叶切除术的可行性。
回顾性分析2014年1月至2021年12月在本中心接受治疗的PTC和LLNM患者。纳入术前诊断为单侧PTC和同侧LLNM的患者。总体而言，102例选择甲状腺叶切除术作为初始手术的患者被纳入甲状腺叶切除术组，96例选择TT的患者被纳入对照组，即TT组。
甲状腺叶切除术组的平均随访时间为47.5±22.2个月。甲状腺叶切除术组患者的甲状旁腺功能减退发生率显著低于TT组（0%对11.5%；p<0.001）。根据Kaplan-Meier曲线分析，甲状腺叶切除术后的RFS与TT术后相当（对数秩检验p=0.80）。甲状腺叶切除术实现促甲状腺激素（TSH）控制不理想的发生率显著低于TT（5.9%对20.8%；p=0.006）。
对于选定的伴有同侧LLNM的单侧PTC，甲状腺叶切除术可能是一种合适的初始治疗方法。有必要进行一项长期随访的随机前瞻性研究。
