Background & objective: Whether to choose total thyroidectomy or lobectomy for the primary lesion of differentiated thyroid carcinoma (DTC) limited in one lobe is controversial. This study was to investigate the patterns of surgical treatment for stage T1-3N0 DTC, and observe the long-term efficacy.
Methods: Clinical data of 153 DTC patients, first treated at Cancer Center of Sun Yat-sen University from 1985 to 2000, were reviewed. The postoperative pathologic stage of these patients was T1-3N0. The multiple centricity of primary lesions, patterns of surgical treatment, and prognosis were analyzed.
Results: Of the 153 DTC patients, 21 had cancer multifocality: 12 had multiple cancer foci in one lobe and 9 had cancer multifocality in both lobes. Ninety-two patients received unilateral lobectomy plus isthmectomy; 44 patients received ipsilateral subtotal lobectomy plus isthmectomy. Among the 9 patients who had cancer multifocality in both lobes, 7 received unilateral lobectomy plus isthmectomy with contralateral subtotal lobectmoy and 2 received bilateral subtotal lobectomy. Eight patients, whose primary lesions were at isthmus, underwent isthmectomy plus bilateral partial lobectomy. Regional lymph node metastasis appeared in 7 patients after initial operation: 6 in the neck and 1 in the upper mediastinum. Five patients had distant metastasis after operation. The 5-, 10-and 15-year survival rates of these 153 patients were 98.7%, 96.1% and 86.9%, respectively. Age, pathologic type, tumor size and distant metastasis affected the survival (P<0.05). The patients whose age was less than 45 years, tumor size was less than 4 cm, pathologic type was papillary or mixed carcinoma, and who had no distant metastasis had relatively good prognosis. Age and distant metastasis were independent prognostic factors.
Conclusions: It is feasible to perform unilateral lobectomy or subtotal lobectomy plus isthmectomy for patients with stage T1-3N0 DTC. The long-term outcomes of stage T1-3N0 DTC patients are relatively well. Age, pathologic type, tumor size and distant metastasis affect prognosis.