Extent of surgery affects survival for papillary thyroid cancer

Ann Surg. 2007 Sep;246(3):375-81; discussion 381-4. doi: 10.1097/SLA.0b013e31814697d9.


Background: The extent of surgery for papillary thyroid cancers (PTC) remains controversial. Consensus guidelines have recommended total thyroidectomy for PTC > or =1 cm; however, no study has supported this recommendation based on a survival advantage. The objective of this study was to examine whether the extent of surgery affects outcomes for PTC and to determine whether a size threshold could be identified above which total thyroidectomy is associated with improved outcomes.

Methods: From the National Cancer Data Base (1985-1998), 52,173 patients underwent surgery for PTC. Survival was estimated by the Kaplan-Meier method and compared using log-rank tests. Cox Proportional Hazards modeling stratified by tumor size was used to assess the impact of surgical extent on outcomes and to identify a tumor size threshold above which total thyroidectomy is associated with an improvement in recurrence and long-term survival rates.

Results: Of the 52,173 patients, 43,227 (82.9%) underwent total thyroidectomy, and 8946 (17.1%) underwent lobectomy. For PTC <1 cm extent of surgery did not impact recurrence or survival (P = 0.24, P = 0.83). For tumors > or =1 cm, lobectomy resulted in higher risk of recurrence and death (P = 0.04, P = 0.009). To minimize the influence of larger tumors, 1 to 2 cm lesions were examined separately: lobectomy again resulted in a higher risk of recurrence and death (P = 0.04, P = 0.04).

Conclusions: The results of this study demonstrate that total thyroidectomy results in lower recurrence rates and improved survival for PTC > or =1.0 cm compared with lobectomy. This is the first study to demonstrate that total thyroidectomy for PTC > or =1.0 cm improves outcomes.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Papillary / mortality
  • Carcinoma, Papillary / pathology
  • Carcinoma, Papillary / surgery*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Prognosis
  • Risk Factors
  • Survival Rate
  • Thyroid Neoplasms / mortality
  • Thyroid Neoplasms / pathology
  • Thyroid Neoplasms / surgery*
  • Thyroidectomy / methods*
  • Treatment Outcome