C Spinelli1, S Strambi2, L Rossi2, S Bakkar2, M Massimino3, A Ferrari3, P Collini4, G Cecchetto5, G Bisogno6, A Inserra7, F Bianco8, P Miccoli2. 1. Division of Surgery, Department of Surgical Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy. c.spinelli@dc.med.unipi.it. 2. Division of Surgery, Department of Surgical Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy. 3. Pediatric Oncology Unit, Istituto Nazionale Tumori, University of Milan, Milan, Italy. 4. Department of Diagnostic Pathology and Laboratory Medicine, Istituto Nazionale Tumori, University of Milan, Milan, Italy. 5. Department of Women's and Children's Health, Pediatric Surgery Unit, University Hospital of Padua, Padua, Italy. 6. Hematology-Oncology Division, Department of Pediatrics, Padova University Hospital of Padua, Padua, Italy. 7. Division of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy. 8. Faculty of Mathematical, Physical and Natural Sciences, University of Pisa, Pisa, Italy.
Abstract
PURPOSE: The extent of surgery for pediatric papillary thyroid carcinoma is debatable. The aim of this study was to evaluate the feasibility of offering pediatric patients a tailored surgical approach based on certain clinical features. METHODS: A national multicenter retrospective review of 250 pediatric patients treated for papillary thyroid carcinoma in a 14-year period was performed. Outcomes of interest included tumor-related features, type of surgery, surgical morbidity, disease-free and overall survival rates. Recurrence was thoroughly analyzed with particular focus on how it correlated with certain patient- and tumor-related features. RESULTS: The majority of patients (58.8 %) had tumors >2 cm in size. Nodal involvement occurred in 115/250 (46 %) patients and distant metastasis in 4 % (10/250). Total thyroidectomy and lobectomy were performed in 90.4 % (226/250) and 9.6 % (24/250) of patients, respectively. The overall rate of surgical complications was 20.8 % (52/250). These included transient and permanent hypoparathyroidism (13.6 and 4.4 %, respectively), and vocal fold palsy (2.8 %). All surgical complications occurred exclusively in the total thyroidectomy group. The rate of recurrent disease was 12 % (30/250) with the vast majority of recurrences (96.6 %) occurring in the total thyroidectomy group. The risk of recurrence correlated significantly with certain tumor-related features (size > 2 cm, multifocality, extrathyroidal invasion, nodal positivity, and distant metastasis). However, it did not correlate with the patient's age or sex. Overall survival was 100 %. CONCLUSION: Pediatric patients are likely to benefit from a tailored surgical strategy. Uniformly offering patients total thyroidectomy seems to be an overly radical approach.
PURPOSE: The extent of surgery for pediatric papillary thyroid carcinoma is debatable. The aim of this study was to evaluate the feasibility of offering pediatric patients a tailored surgical approach based on certain clinical features. METHODS: A national multicenter retrospective review of 250 pediatric patients treated for papillary thyroid carcinoma in a 14-year period was performed. Outcomes of interest included tumor-related features, type of surgery, surgical morbidity, disease-free and overall survival rates. Recurrence was thoroughly analyzed with particular focus on how it correlated with certain patient- and tumor-related features. RESULTS: The majority of patients (58.8 %) had tumors >2 cm in size. Nodal involvement occurred in 115/250 (46 %) patients and distant metastasis in 4 % (10/250). Total thyroidectomy and lobectomy were performed in 90.4 % (226/250) and 9.6 % (24/250) of patients, respectively. The overall rate of surgical complications was 20.8 % (52/250). These included transient and permanent hypoparathyroidism (13.6 and 4.4 %, respectively), and vocal fold palsy (2.8 %). All surgical complications occurred exclusively in the total thyroidectomy group. The rate of recurrent disease was 12 % (30/250) with the vast majority of recurrences (96.6 %) occurring in the total thyroidectomy group. The risk of recurrence correlated significantly with certain tumor-related features (size > 2 cm, multifocality, extrathyroidal invasion, nodal positivity, and distant metastasis). However, it did not correlate with the patient's age or sex. Overall survival was 100 %. CONCLUSION: Pediatric patients are likely to benefit from a tailored surgical strategy. Uniformly offering patients total thyroidectomy seems to be an overly radical approach.
Authors: K D Newman; T Black; G Heller; R G Azizkhan; G W Holcomb; C Sklar; V Vlamis; G M Haase; M P La Quaglia Journal: Ann Surg Date: 1998-04 Impact factor: 12.969
Authors: Jaromír Astl; Martin Chovanec; Petr Lukeš; Rami Katra; Marcela Dvořáková; Petr Vlček; Pavla Sýkorová; Jan Betka Journal: Int J Pediatr Otorhinolaryngol Date: 2014-04-01 Impact factor: 1.675
Authors: F Pacini; E Brianzoni; C Durante; R Elisei; M Ferdeghini; L Fugazzola; S Mariotti; G Pellegriti Journal: J Endocrinol Invest Date: 2015-08-12 Impact factor: 4.256
Authors: Marloes Nies; Rena Vassilopoulou-Sellin; Roland L Bassett; Sireesha Yedururi; Mark E Zafereo; Maria E Cabanillas; Steven I Sherman; Thera P Links; Steven G Waguespack Journal: J Clin Endocrinol Metab Date: 2021-03-25 Impact factor: 5.958