American Surgical Association

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Extent Of Surgery For Papillary Thyroid Cancer Is Not Associated With Survival: An Analysis Of 69,136 Patients
Mohamed Abdelgadir Adam*, Lin Gu*, Michaela A Dinan*, Douglas Tyler, Shelby D Reed*, Sanziana Roman*, Julie A Sosa*, Pura John*
Duke University School of Medicine, Durham, NC

Guidelines recommend total thyroidectomy (TT) for papillary thyroid cancers (PTC) >1cm based on older data demonstrating an overall survival (OS) advantage for TT over lobectomy (PT). We examine the association of extent of surgery with OS based on tumor size in a large contemporary cohort.

Adult PTC patients with tumors ≥1cm undergoing thyroidectomy in the ACS National Cancer Database, 1998-2006, were included. Cox proportional hazards models were applied to measure the impact of extent of surgery on OS in relation to tumor size while adjusting for patient factors, including comorbidities, extrathyroidal extension, multifocality, nodal status, and radioiodine treatment.

Among 69,136 PTC patients, 7,674 underwent PT and 61,462 TT; 53% had tumors1-2cm and 36% were 2.1-4cm. Compared to PT, TT patients were younger (mean 45 TT vs. 46 years PT), and had more nodal (28% vs. 7%), extrathyroidal (17% vs. 6%), and multifocal disease (44% vs. 28%), all p<0.0001. Patient age, male gender, black race, tumor size >2cm, lower income, and presence of nodal or distant metastases were associated with higher mortality rates (p<0.0001). After multivariable adjustment, OS was similar for PT versus TT in all patients with tumors ≥1cm (HR 0.99; 0.89-1.10; p=0.85); 1-2cm (HR 0.98; 0.83-1.16; p=0.83), and 2.1-4cm (HR 1.07; 0.90-1.27; p=0.47).
Despite guidelines advocating TT for PTC tumors >1cm, our analysis revealed no survival advantage associated with total thyroidectomy compared to lobectomy. These findings call into question whether tumor size should be an absolute indication for total thyroidectomy, given its potentially increased morbidity.

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