Completion thyroidectomy(CT)is employed after lobectomy when histopathological results mandates total removal of the gland as in case of well differentiated thyroid carcinoma(DTC).It is also employed as a second stage...Completion thyroidectomy(CT)is employed after lobectomy when histopathological results mandates total removal of the gland as in case of well differentiated thyroid carcinoma(DTC).It is also employed as a second stage thyroid surgery when unfavorable events occur as in recurrent laryngeal nerve injury or when the surgeon finds out the case is beyond his/her expertise in an attempt to protect the contralateral side and allowing time for recovery or for an expert surgeon to help.展开更多
Background:Continuing controversy exists in diferent guidelines’recommendations regarding whether total thyroidectomy(TT)or lobectomy is the optimal surgery for patients with low-risk papillary thyroid carcinoma(PTC)...Background:Continuing controversy exists in diferent guidelines’recommendations regarding whether total thyroidectomy(TT)or lobectomy is the optimal surgery for patients with low-risk papillary thyroid carcinoma(PTC).Diverse perceptions of the risk of completion TT after lobectomy are the main debate between guidelines and institutions.Methods:Patients who underwent thyroidectomy and prophylactic central lymph node dissection for≤4 cm PTC(January 2007 to December 2020)by high-volume surgeons were included.Patients with preoperatively known highrisk characteristics or suspicious bilateral multifocality were excluded.The pathological fndings were defned as the risk stratifcations of completion TT from low to high to evaluate which initial surgical procedure could allow more patients to meet the criteria of optimal surgical extent.Results:Of 4965 consecutive patients met lobectomy criteria as the initial operation.Aggressive histological subtypes were found in 2.5%of patients,T3b disease in 1.1%,T4 disease in 3.1%,LNs involved≤5 in 29.5%,LNs involved>5 in 3.1%,and incidental bilateral multifocality in 7.9%.According to our defned risk stratifcation system,TT and lobectomy would be considered the optimal initial procedure in 12.0%and 67.2%PTC patients with a tumor≤1 cm and 28.7%and 36.6%in the 1-4 cm groups in our real-world cohort,respectively.Conclusion:Lobectomy alone,as an initial procedure,could allow more low-risk PTC patients with a tumor either≤1 cm or 1-4 cm to achieve the optimal surgical extent.Moreover,surgeons should balance the high-risk characteristics and complication risks during surgery to re-evaluate surgical decision-making.展开更多
文摘Completion thyroidectomy(CT)is employed after lobectomy when histopathological results mandates total removal of the gland as in case of well differentiated thyroid carcinoma(DTC).It is also employed as a second stage thyroid surgery when unfavorable events occur as in recurrent laryngeal nerve injury or when the surgeon finds out the case is beyond his/her expertise in an attempt to protect the contralateral side and allowing time for recovery or for an expert surgeon to help.
基金supported by grants from the“Ten Thousand People Plan”of Yunnan Province-Medical Experts Project[RLCRC20210412].
文摘Background:Continuing controversy exists in diferent guidelines’recommendations regarding whether total thyroidectomy(TT)or lobectomy is the optimal surgery for patients with low-risk papillary thyroid carcinoma(PTC).Diverse perceptions of the risk of completion TT after lobectomy are the main debate between guidelines and institutions.Methods:Patients who underwent thyroidectomy and prophylactic central lymph node dissection for≤4 cm PTC(January 2007 to December 2020)by high-volume surgeons were included.Patients with preoperatively known highrisk characteristics or suspicious bilateral multifocality were excluded.The pathological fndings were defned as the risk stratifcations of completion TT from low to high to evaluate which initial surgical procedure could allow more patients to meet the criteria of optimal surgical extent.Results:Of 4965 consecutive patients met lobectomy criteria as the initial operation.Aggressive histological subtypes were found in 2.5%of patients,T3b disease in 1.1%,T4 disease in 3.1%,LNs involved≤5 in 29.5%,LNs involved>5 in 3.1%,and incidental bilateral multifocality in 7.9%.According to our defned risk stratifcation system,TT and lobectomy would be considered the optimal initial procedure in 12.0%and 67.2%PTC patients with a tumor≤1 cm and 28.7%and 36.6%in the 1-4 cm groups in our real-world cohort,respectively.Conclusion:Lobectomy alone,as an initial procedure,could allow more low-risk PTC patients with a tumor either≤1 cm or 1-4 cm to achieve the optimal surgical extent.Moreover,surgeons should balance the high-risk characteristics and complication risks during surgery to re-evaluate surgical decision-making.
