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Milestones on extent of thyroidectomy
| Year Author Institution |
Periods Enrolled patients |
Point |
|---|---|---|
| 1913 Halsted |
1902-190339 Graves’ disease | ITA ligation during operation in Graves’ patients. Then definite surgery after 2-4 weeks later (interval completion total thyroidectomy). |
| 1953 I. Macdonald |
23 patients | Total thyroidectomy is mandatory due to 13% contralateral, 13% lateral metastasis, and overall 43% (10/23) extrathyroidal extension. |
| 1959 R. Clark MD Anderson |
1941-1958 324 patients | Total thyroidectomy was recommended due to 54% of glandular dissemination. Complication rate in this study was 34% tetany and 12.5% permanent hypoparathyroidism. |
| 1963 R. Rose |
1st ultrasonography on neck, 1963 Holmes | 61.7% (21/34) contralateral cancer was detected in prophylactic total thyroidectomy after formal lobectomy. 24.4% recurrence in 19 years in lobectomy patients. |
| 1998 Hay Mayo |
1940-1991 1685/1798 patients were grouped into AMES low risk |
Total thyroidectomy was recommended even in low-risk PTC, due to high risk of locoregional recurrence. But there was no difference in mortality during 54 years (mean 18 years). |
| 2000, Kebebew, Duh, Clark, UCSF |
Low risk DTC | Lobectomy rather than total thyroidectomy in low risk differentiated thyroid cancer patients if higher complication rate expected. |
| 2005 Machens |
366 PTCs 134 TFCs |
Earlier intervention is warranted to keep suspicious thyroid nodules from growing above 2 cm. Completion or reoperation rate was 66% in PTC and 78% of TFC |
| 2007 Bilimoria |
1985-1998 51173 NCDB All (PTMC 20%) |
1st study proved TT improves oncologic outcomes in PTC ≥1.0 cm |
| 2010 Mendelsohn |
1988-2001 22724 SEER DB All (PTMC 28%) |
Controlling for tumor size, no survival difference TT vs. TL: increased tumor size, extrathyroidal extent, positive nodal status, and increased age displayed significantly worse DSS and OS (P.001). 4 cm |
| 2018 SMC |
1996-2005 3174 All, 1-4 cm (48.5%) |
Gross ETE invading only strap muscles affected on long term recurrence, but not on mortality. |
| 2019 AMC Song |
1998-2007 2345 1-4 cm patients |
Lobectomy as initial surgical approach. Tumor size should not be an absolute indication for TT. Recur rate (lobectomy 6.3%, TT 4.7%, 9.8 years). |
| 2020 Nishino & Jacob |
Problems of T3b and 8th edition of TNM stage. Gross suspicion of ETE into strap muscles (T3b) should be confirmed by microscopic examination. |
|
| 2020 Severance |
1973-2018 19914 SEER DB 17837 ≤4 cm |
Strap muscle invasion did not significantly impact DSS. Regardless of tumor size or cause of death. |
| 2020 Suman |
2004-2014 8083/38490 NCDB TL 6531 iTL 1552 |
Substantial number (19.2%) with tumor size above 1 cm and high-risk features undergo thyroid lobectomy for PTC. Exclusion of high-risk features is important. |
CND: central neck dissection, Cx: complication, DSS: disease specific survival, DTC: differentiated thyroid cancer, ETE: extrathyroidal extension, hypoPTH: hypoparathyroidism, ITA: inferior thyroid artery, iTL: inappropriate thyroid lobectomy, LND: lateral neck dissection, NCDB: National Cancer Database, OS: overall survival, PTC: papillary thyroid cancer, PTMC: papillary thyroid microcarcinoma, SEER DB: Surveillance, Epidemiology, and End Results program database, STT: subtotal thyroidectomy, TL: appropriate thyroid lobectomy, TT: total thyroidectomy