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CQ17. Does Total (or Near Total) Thyroidectomy Improve the Prognosis of Papillary Carcinoma Patients Compared to Lobectomy or Lobectomy Isthmectomy?

  • Tsuneo Imai
  • Hiroya Kitano
  • Iwao Sugitani
  • Nobuyuki Wada
Chapter

Abstract

In Western guidelines, total (or near total) thyroidectomy is recommended for overt clinical carcinoma (Recommendation rating A) [1, 2]. It is also confirmed that total thyroidectomy is most likely to be performed based on the results of the carcinoma registry in the United States and questionnaires in Europe and United States [3, 4]. In Japan, however, lobectomy with isthmectomy is the most widely adopted method for papillary carcinoma regardless of the perceived level of carcinoma risk. In Western countries, the general strategy is a combination of total thyroidectomy and RAI therapy followed by TSH suppression and constant thyroglobulin measurement. However, in Japan, it is practically impossible to perform RAI therapy routinely. As indicated below, data with a high evidence level for the superiority of total thyroidectomy are lacking. Therefore, the committee developed a consensus for the appropriate extent of surgery based on the current Japanese situation.

Keywords

Total Thyroidectomy Papillary Carcinoma Recurrent Laryngeal Nerve Paralysis Remnant Thyroid High Evidence Level 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214 (Others)PubMedCrossRefGoogle Scholar
  2. 2.
    Pacini F, Schlumberger M, Dralle H et al (2006) European consensus for the management of patients with differentiated thyroid carcinoma of the follicular epithelium. Eur J Endocrinol 154:787–803 (Others)PubMedCrossRefGoogle Scholar
  3. 3.
    Bilimoria KY, Bentrem DJ, Ko CY et al (2007) Extent of surgery affects survival for papillary thyroid cancer. Ann Surg 246:375–381 (RS)PubMedCrossRefGoogle Scholar
  4. 4.
    Shigematsu N, Takami H, Ito N et al (2005) Nationwide survey on the treatment policy for well-differentiated thyroid cancer—results of a questionnaire distributed at the 37th meeting of the Japanese Society of Thyroid Surgery. Endocr J 52:479–491 (RS)PubMedCrossRefGoogle Scholar
  5. 5.
    Samaan NA, Schultz PN, Hickey RC et al (1992) The results of various modalities of treatment of well differentiated thyroid carcinomas: a retrospective review of 1599 patients. J Clin Endocrinol Metab 75:714–720 (RS)PubMedCrossRefGoogle Scholar
  6. 6.
    Hay ID, Bergstralh EJ, Grant CS et al (1999) Impact of primary surgery on outcome in 300 patients with pathologic tumor-node-metastasis stage III papillary thyroid carcinoma treated at one institution from 1940 through 1989. Surgery 126:1173–1181 (RS)PubMedCrossRefGoogle Scholar
  7. 7.
    Loh KC, Greenspan FS, Gee L et al (1997) Pathological tumor-node-metastasis (pTNM) staging for papillary and follicular thyroid carcinomas: a retrospective analysis of 700 patients. J Clin Endocrinol Metab 82:3553–3562 (RS)PubMedCrossRefGoogle Scholar
  8. 8.
    Segal K, Friedental R, Lubin E et al (1995) Papillary carcinoma of the thyroid. Otolaryngol Head Neck Surg 113:356–363 (RS)PubMedCrossRefGoogle Scholar
  9. 9.
    Mazzaferri EL, Jhiang SM (1994) Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 97:418–428 (RS)PubMedCrossRefGoogle Scholar
  10. 10.
    Hay ID, Grant CS, Bergstralh EJ et al (1998) Unilateral total lobectomy: is it sufficient surgical treatment for patients with AMES low-risk papillary thyroid carcinoma? Surgery 124:958–964 (RS)PubMedCrossRefGoogle Scholar
  11. 11.
    Lundgren CI, Hall P, Dickman PW et al (2007) Influence of surgical and postoperative treatment on survival in differentiated thyroid cancer. Br J Surg 94:571–577 (RS)PubMedCrossRefGoogle Scholar
  12. 12.
    Handkiewicz-Junak D, Wloch J, Roskosz J et al (2007) Total thyroidectomy and adjuvant radioiodine treatment independently decrease locoregional recurrence risk in childhood and adolescent differentiated thyroid cancer. J Nucl Med 48:879–888 (RS)PubMedCrossRefGoogle Scholar
  13. 13.
    Shaha AR, Shah JP, Loree TR (1997) Low-risk differentiated thyroid cancer: the need for selective treatment. Ann Surg Oncol 4:328–333 (RS)PubMedCrossRefGoogle Scholar
  14. 14.
    Kim S, Wei JP, Braveman JM et al (2004) Predicting outcome and directing therapy for papillary thyroid carcinoma. Arch Surg 139:390–394 (RS)PubMedCrossRefGoogle Scholar
  15. 15.
    Wanebo H, Coburn M, Teates D et al (1998) Total thyroidectomy does not enhance disease control or survival even in high-risk patients with differentiated thyroid cancer. Ann Surg 227:912–921 (RS)PubMedCrossRefGoogle Scholar
  16. 16.
    Hundahl SA, Fleming ID, Fremgen AM et al (1998) A National Cancer Data Base report on 53, 856 cases of thyroid carcinoma treated in the U.S., 1985–1995. Cancer 83:2638–2648 (RS)PubMedCrossRefGoogle Scholar
  17. 17.
    Haigh PI, Urbach DR, Rotstein LE (2005) Extent of thyroidectomy is not a major determinant of survival in low- or high-risk papillary thyroid cancer. Ann Surg Oncol 12:81–89 (RS)PubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2013

Authors and Affiliations

  • Tsuneo Imai
    • 1
  • Hiroya Kitano
    • 2
  • Iwao Sugitani
    • 3
  • Nobuyuki Wada
    • 4
  1. 1.Department of Breast & Endocrine SurgeryNagoya UniversityNagoyaJapan
  2. 2.Division of Otolaryngology, Head & Neck Surgery, Department of Sensory and Motor Organ, Faculty of MedicineTottori UniversityTottoriJapan
  3. 3.Division of Head and NeckCancer Institute Hospital, Japanese Foundation for Cancer ResearchTokyoJapan
  4. 4.Department of SurgeryYokohama City UniversityYokohamaJapan

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