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Background Although the incidence of papillary thyroid carcinoma (PTC) has increased during the recent years, most of the PTCs are slow growing and considered as low-risk tumors with an excellent prognosis. This observed increase in small tumors leads to many controversies regarding the optimal surgical approach, and the extent of surgery for low-risk PTC is still the subject of debate. Recently, there is a trend toward utilizing a less-aggressive surgical approach, including the option of hemithyroidectomy for small PTCs up to 4 cm. Patients and methods This study included 60 patients with a proven diagnosis of PTC. According to the guidelines of the British Thyroid Association, the American Thyroid Association, and the American Joint Committee on Cancer, these patients would have low-risk PTCs and considered eligible for hemithyroidectomy (total lobectomy with isthmusectomy) as an initial treatment and followed up for about 5 years to detect recurrence and survival rate. Results Hemithyroidectomy was performed as an initial treatment. Completion thyroidectomy (CTx) was performed in five (8.33%) patients in the postoperative period within 1 week after the initial operation owing to identifying high-risk features in the final histopathology. During the follow-up period of the 60 patients, there was no locoregional recurrence. Recurrence was observed in three (5%) patients in the contralateral thyroid lobe within 3–4 years and was treated with a second surgery in the form of CTx. The overall rate of CTx was eight (13.33%) of 60 patients. The prognosis and the 5-year survival rate were excellent (100%). Conclusion Hemithyroidectomy in appropriately selected patients is an optimal surgical approach for treating low-risk PTC, and if recurrence occurs in the contralateral lobe, it can be treated safely by CTx, which yielded excellent curative results.

Optimal therapeutic strategy in low advanced papillary thyroid carcinoma (PTC) is still a matter of debate. The management differs depending on the country. A prospective non-randomized study was performed to evaluate whether less extensive surgery could be a safe, acceptable, and sufficient therapeutic option in PTC cT1N0M0 patients. The present paper summarizes the results of over a 5-year follow-up Material: Our prospective group (PG) treated between 2011 and 2015 consisted of 139 patients with cT1aN0M0 PTC who underwent lobectomy (LT) as initial surgical treatment (PGcT1aN0M0 group) and 102 cT1bN0M0 patients in whom total thyroidectomy (TT) with unilateral central neck dissection (CND) was performed (PGcT1bN0M0). PG was compared with the retrospective group (RG) of patients who underwent TT with bilateral CND between 2004 and 2006: 103 cT1aN0M0 patients (RGcT1aN0M0) and 91cT1bN0M0 (RGcT1bN0M0). The risks of reoperation, cancer relapse and postoperative complications were analyzed. Results: Only 12 cT1aN0M0 patients (7.6%) withdrew from the trial and underwent TT with bilateral CND. Over 90% of patients accepted less extensive surgery. In 4 cT1aN0M0 cases, TT with CND was performed due to lymph node metastases found intraoperatively. The initial clinical stage according to the TNM/AJCC 7th edition was confirmed histologically in 77% of cases in PGT1aN0M0 and in 72% in PGT1bN0M0, respectively. 24 PGcT1aN0M0 patients were reoperated on. In this group, cancer lesions in the postoperative histological specimens were found in 8 cases (32%). Five-year disease-free survival (DFS) was excellent. However, no statistically significant differences were found between PG and RG groups (99.3% in PGcT1aN0M0 and 99.0%, in RGcT1aN0M0; p = 0.41 and 98%, in PGcT1bN0M0 and 94.4% in RGcT1bN0M0; p=0.19). No significant differences were observed in the incidence of early paresis of the recurrent laryngeal nerves between PG and RG. However, as predicted, LT completely eliminated the risk of postoperative hypoparathyroidism. Summary: The results of the prospective clinical trial confirm that less extensive surgery in adequately selected low-advanced PTC patients is both safe and sufficient. [ABSTRACT FROM AUTHOR]

Optimal therapeutic strategy in low advanced papillary thyroid carcinoma (PTC) is still a matter of debate. The management differs depending on the country.A prospective non-randomized study was performed to evaluate whether less extensive surgery could be a safe, acceptable, and sufficient therapeutic option in PTC cT1N0M0 patients. The present paper summarizes the results of over a 5-year follow-upMaterialOur prospective group (PG) treated between 2011 and 2015 consisted of 139 patients with cT1aN0M0 PTC who underwent lobectomy (LT) as initial surgical treatment (PGcT1aN0M0 group) and 102 cT1bN0M0 patients in whom total thyroidectomy (TT) with unilateral central neck dissection (CND) was performed (PGcT1bN0M0). PG was compared with the retrospective group (RG) of patients who underwent TT with bilateral CND between 2004 and 2006: 103 cT1aN0M0 patients (RGcT1aN0M0) and 91cT1bN0M0 (RGcT1bN0M0). The risks of reoperation, cancer relapse and postoperative complications were analyzed.ResultsOnly 12 cT1aN0M0 patients (7.6%) withdrew from the trial and underwent TT with bilateral CND. Over 90% of patients accepted less extensive surgery. In 4 cT1aN0M0 cases, TT with CND was performed due to lymph node metastases found intraoperatively. The initial clinical stage according to the TNM/AJCC 7th edition was confirmed histologically in 77% of cases in PGT1aN0M0 and in 72% in PGT1bN0M0, respectively. 24 PGcT1aN0M0 patients were reoperated on. In this group, cancer lesions in the postoperative histological specimens were found in 8 cases (32%). Five-year disease-free survival (DFS) was excellent. However, no statistically significant differences were found between PG and RG groups (99.3% in PGcT1aN0M0 and 99.0%, in RGcT1aN0M0; p = 0.41 and 98%, in PGcT1bN0M0 and 94.4% in RGcT1bN0M0; p=0.19). No significant differences were observed in the incidence of early paresis of the recurrent laryngeal nerves between PG and RG. However, as predicted, LT completely eliminated the risk of postoperative hypoparathyroidism.SummaryThe results of the prospective clinical trial confirm that less extensive surgery in adequately selected low-advanced PTC patients is both safe and sufficient.

Background Although the incidence of papillary thyroid carcinoma (PTC) has increased during the recent years, most of the PTCs are slow growing and considered as low-risk tumors with an excellent prognosis. This observed increase in small tumors leads to many controversies regarding the optimal surgical approach, and the extent of surgery for low-risk PTC is still the subject of debate. Recently, there is a trend toward utilizing a less-aggressive surgical approach, including the option of hemithyroidectomy for small PTCs up to 4 cm. Patients and methods This study included 60 patients with a proven diagnosis of PTC. According to the guidelines of the British Thyroid Association, the American Thyroid Association, and the American Joint Committee on Cancer, these patients would have low-risk PTCs and considered eligible for hemithyroidectomy (total lobectomy with isthmusectomy) as an initial treatment and followed up for about 5 years to detect recurrence and survival rate. Results Hemithyroidectomy was performed as an initial treatment. Completion thyroidectomy (CTx) was performed in five (8.33%) patients in the postoperative period within 1 week after the initial operation owing to identifying high-risk features in the final histopathology. During the follow-up period of the 60 patients, there was no locoregional recurrence. Recurrence was observed in three (5%) patients in the contralateral thyroid lobe within 3-4 years and was treated with a second surgery in the form of CTx. The overall rate of CTx was eight (13.33%) of 60 patients. The prognosis and the 5-year survival rate were excellent (100%). Conclusion Hemithyroidectomy in appropriately selected patients is an optimal surgical approach for treating low-risk PTC, and if recurrence occurs in the contralateral lobe, it can be treated safely by CTx, which yielded excellent curative results. [ABSTRACT FROM AUTHOR]

Purpose: To describe the outcomes and the incidence of adverse events following active surveillance (AS) versus immediate surgery in patients with low-risk papillary thyroid carcinoma (PTC). Methods: We prospectively evaluated 286 patients who attended the Hospital de Clínicas, with a single thyroid nodule <1.5 cm classified as Bethesda category V or VI (PTC). Those patients with no aggressive features were considered as harboring a low-risk PTC and were offered AS or immediate surgery. For patients who opted for AS, surgery was recommended if tumor progression was observed. Post-operative adverse events were recorded for those patients treated with surgery (after AS or immediate surgery). Results: From 286 eligible patients, 164 harbored a low-risk PTC. Among these, 75% (n = 123) underwent immediate surgery and 25% (n = 41) opted for AS. Within the last group, increase in tumor size more than 3 mm was observed in 14.6 and 4.8% was diagnosed with lymph-node metastases after a median of 37.5 months (range, 12–65) of follow-up. One hundred and thirty five patients underwent surgery: in 123, it was immediate after diagnosis and in 12 after a median of 35 months (range, 12–65) of AS. Both groups had excellent oncological outcomes. The frequency of postoperative adverse events was 24.4%, which was permanent in 9.6% of cases. The immediate-surgery group presented higher incidence of permanent vocal cord paralysis (2.4 vs. 0%); permanent hypoparathyroidism (5.7 vs. 0%) and local complications (4 vs. 2.4%) compared with the AS group, all non-statistically significant. Conclusions: The high incidence of postoperative complications observed in our media could be avoided if AS was performed as the initial approach in patients with low-risk PTCs. The frequency of tumor growth and LN metastases during AS was similar to other series. [ABSTRACT FROM AUTHOR]