Prognosis and Postoperative Complications of Wide-Field Isthmusectomy for Node-Negative Papillary Thyroid Carcinoma Limited to the Isthmus.

Abstract

ImportanceThe extent of surgical resection for papillary thyroid carcinoma (PTCs) located in the isthmus has remained a matter of considerable debate.ObjectiveTo investigate the association between the extent of wide-field isthmusectomy and complications and recurrences.DesignClinicopathologic documents of patients who received total thyroidectomy and wide-field isthmusectomy were recorded.SettingA retrospective review study.ParticipantsPatients with single tumor in the isthmus with no cervical lymph node metastasis were selected.Intervention or ExposuresPatients received total thyroidectomy with neck dissection, or wide-field isthmusectomy with paratracheal and prelaryngeal lymph node dissection.Main Outcome MeasuresThe locoregional results, complications, and rate of patients who were not required to receive thyroid-stimulating hormone suppression therapy were compared.ResultsA total of 389 patients were included in the study and divided into 3 groups. One hundred and nineteen (30.6%) patients were performed with wide-field isthmusectomy with a distance <0.5 cm (Group I), and 190 (48.8%) patients with a distance ≥0.5 cm (Group II). Eighty (20.6%) underwent total thyroidectomy (Group III). Eighty (67.2%) of 119 patients in Group I and 125 (65.8%) of 190 patients in Group II did not take medication at the mean follow-up of 37 months. Locoregional recurrence developed in 22 patients (18.5%) of Group I, 16 (8.4%) patients of Group II, and 5 (2.6%) patients of Group III. The overall morbidity was 6 (5.0%) in Group I, 14 (7.4%) in Group II, and 21 (26.5%) in Group III.ConclusionsWide-field isthmusectomy with a 0.5 cm distance may be a sufficient treatment for selected patients with PTC limited to the isthmus.RelevanceWild-field isthmusectomy and limited neck dissection may be a sufficient procedure for isthmic PTC. Further research is needed to determine whether prophylactic central compartment neck dissection can be omitted during isthmusectomy for these patients.