Partial Thyroid Surgery Recommended for Papillary Cancer

Researchers Evaluate Lobectomy or Total Thyroidectomy for Papillary Cancer

lobectomy, total thyroidectomy, papillary thyroid cancer, thyroid surgery
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In 2017, the American Cancer Society estimates that about 56,870 new cases of thyroid cancer will be diagnosed: 42,470 in women, and 14,400 in men.

The standard treatment for thyroid cancer is a surgery to remove the cancer. Usually, experts recommend that the surgery remove the entire thyroid gland. This full removal of the thyroid gland is known as a total thyroidectomy.

As of 2017, the American Thyroid Association’s guidelines for thyroid cancer recommend that a patient receive a total thyroidectomy for all types of thyroid cancer.

The only exception is made for the smallest thyroid tumors that are less than 1 cm in diameter.

In the United States, about 80 percent of all thyroid cancers are papillary cancer, which is also referred to as papillary carcinoma or papillary adenocarcinoma. Papillary cancer is more likely to show up in only one side of the thyroid—known as a lobe—and this type of thyroid cancer usually grows very slowly. Papillary cancer can, however, spread to the lymph nodes in the neck. Even when it has spread to the lymph nodes, statistics show that papillary cancer is highly treatable, and is rarely fatal.

Research study results presented at the 2016 Clinical Congress of the American College of Surgeons suggested that many papillary thyroid cancer patients would benefit from a less expensive, less invasive, and more effective partial thyroid surgery known as lobectomy, versus total thyroidectomy. In a lobectomy, only the affected lobe is surgically removed.

Specifically, investigators from Tulane University School of Medicine in New Orleans and Johns Hopkins School of Medicine in Baltimore determined that for most papillary thyroid cancer patients, a total thyroidectomy is more expensive and causes a reduction in quality of life when compared to lobectomy.

The study’s lead investigator Zaid Al-Qurayshi, MD, MPH, of the University of Iowa Hospital, said:

Our findings are showing that from the economic standpoint, performing lobectomy instead of total thyroidectomy in patients who have had a biopsy suspicious for papillary thyroid carcinoma is associated with a lower cost and better effectiveness. It is important to note, this finding does not mean that lobectomy is only a cost-effective alternative; we call a strategy 'cost-effective' compared with the alternative if it costs more, or the same, but is associated with better effectiveness.

Another study compared thyroid cancer survival and recurrence rates in patients who had a total thyroidectomy versus lobectomy. The 10-year study was conducted by the Memorial Sloan Kettering Cancer Center in New York. In that study, researchers evaluated patients with thyroid cancers less than 4 cm in size that had not spread outside the lobe. The researchers found no significant differences in the 10-year survival or rate of thyroid cancer recurrence in the two groups. This research showed that over time, in terms of thyroid cancer survival and recurrence risk, lobectomy was as effective as total thyroidectomy for smaller thyroid cancers.

Lobectomy Outcomes

According to researchers, for a target group of papillary cancer patients, lobectomy is better than total thyroidectomy for a number of reasons, including:

  • Lobectomy is a shorter surgery than a total thyroidectomy, and can usually be performed on an outpatient basis.
  • Lobectomy has a lower risk of surgical complications compared to total thyroidectomy.
  • Recuperation after lobectomy is faster compared to total thyroidectomy
  • After lobectomy, you may not need thyroid hormone replacement (or if you do, the dose may be lower). If you have a total thyroidectomy, you will need lifelong thyroid hormone replacement medication.
  • Lobectomy patients report a better quality of life after surgery when compared to total thyroidectomy.

Are You a Candidate for Lobectomy?

Research has shown that lobectomy can be effective when the papillary thyroid cancer meets three key criteria:

  1. The papillary thyroid cancer is Stage I or II only
  2. The tumor is located in only one lobe of the thyroid
  3. The tumor is 4 cm or less in size

If you have papillary thyroid cancer that fits these parameters, you may want to discuss lobectomy versus total thyroidectomy with your thyroid surgeon.

Other Information for Patients

The issue of thyroid surgeons brings up an important point. Even with a lobectomy, complications are more likely if your surgeon has less experience performing thyroid surgeries. It’s important to learn as much as you can and choose a surgeon who has extensive experience in thyroid surgery.

Sources:

Nixon, IJ et al. Thyroid lobectomy for treatment of well differentiated intrathyroid malignancy. Surgery. 2011. October 14, 2011

Noureldine, S. and Kandil, E. “Removal of lobe instead of total thyroid may benefit papillary thyroid cancer patients.” American College of Surgeons: 2016 Clinical Congress Proceedings. 

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