Endocrine Abstracts

Abstract: An individualized risk-based approach to the treatment of thyroid cancer is being extensively discussed in the recent literature, but controversies remain about the ideal surgical approach. In particular, if some data showed that properly selected thyroid cancer patients can be treated with lobectomy (LT) with excellent clinical outcomes, other results demonstrated an increased incidence of persistent recurrent disease in patients submitted to LT with respect to those treated with total thyroidectomy (TT). This study was aimed to describe clinical outcomes in a retrospective large series of low and intermediate risk thyroid cancer patients treated with LT or TT.

Methods: We evaluated retrospectively 336 patients affected with differentiated thyroid cancers (DTC); 292 of them were treated with TT and 44 with LT. The initial surgical treatment was not chosen based on the risk class. The median age was 48 yrs, 274 were females and 62 males. Remission or persistent/recurrent disease was defined on the basis of biochemical and/or structural evidence of disease after a median follow-up period of 65 months.

Results: Only 1/292 patients treated with TT needed additional therapy (surgery for malignant lymph node metastases), and none of them was submitted to radioiodine ablation. On the other hand, 15/44 patients treated with lobectomy were submitted to following treatment (completion thyroidectomy alone in 3, associated with lymphadenectomy and radioiodine treatment in 12 cases). As far as the outcome concerns, remission was documented in 281/292 cases (96.2%) and 30/44 cases (68.2%) in the TT and LT groups, respectively (P<0.0001).

Conclusions: Our data suggest that lobectomy should be performed only in patients with a very low risk at diagnosis, in order to avoid the need for a second treatment. Moreover, since virtually all patients treated with TT were cured after surgery, our data support the selective use of radioiodine ablation treatment.