American Surgical Association
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Extent of Surgery Affects Survival For Papillary Thyroid Cancer: Analysis of 94,564 Patients
Karl Y Bilimoria, MD*1, 2, David J. Bentrem, MD*1, Clifford Y Ko, MD*2, R Scott Jones, MD2, Andrew K Stewart, MD*2, David P Winchester, MD2, Mark S. Talamonti, MD*1, Cord Sturgeon, MD*1 - 1Northwestern University, Department of Surgery, Chicago IL and 2American College of Surgeons, Cancer Programs, Chicago, IL

OBJECTIVE(S): Extent of surgery for papillary thyroid cancers (PTC) remains controversial. Consensus guidelines have recommended total thyroidectomy for any PTC >=1cm; however, no adequately powered study has supported this recommendation based on a survival advantage. Our objective was to determine if the extent of surgery affected recurrence and survival when stratified by tumor size.
METHODS: From the National Cancer Data Base (1985-2003), there were 76,856 (83.0%) patients who underwent total thyroidectomy and 15,708 (17.0%) who underwent lobectomy. Survival was estimated by the Kaplan-Meier method and compared using log-rank tests. Cox Proportional Hazards Modeling with stratified analyses was utilized to assess the impact of surgical extent on recurrence and survival.
RESULTS: For PTC <1cm extent of surgery did not impact recurrence or survival. For tumors >=1cm, lobectomy resulted in higher likelihood of recurrence (Hazard Ratio [HR] 1.34, 95% Confidence Interval [CI] 1.09-1.64) and death (HR 1.26, CI 1.02-1.50). To minimize the influence of larger tumors, 1-2cm tumors were examined separately: lobectomy again resulted in higher likelihood of recurrence (HR 1.41, 1.10-1.80) and death (HR 1.43, CI 1.07-1.91). Males, age >45 years, blacks, positive nodal status, distant metastases, and no radioiodine administration were also independent predictors of a higher risk of recurrence and death (P<.0001).
CONCLUSIONS: We found that total thyroidectomy resulted in lower recurrence and improved survival for PTC >=1cm compared to lobectomy. This is the first study to demonstrate that total thyroidectomy for PTC >=1cm may improve outcomes, even in the presence of other low-risk features.

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