Background/Objectives: In the recent decades the incidence of pediatric differentiated thyroid carcinoma (DTC) increased. DTC in pediatric age is rare and has an excellent prognosis. Nevertheless, the best surgical treatment is unclear, and the debated focus on radical vs conservative surgery. Total thyroidectomy has a lower rate of recurrence but an higher risk of complications. Our study purposes to evaluate the long-term prognosis of pediatric patients who underwent surgical treatment for thyroid cancer, both by total thyroidectomy and hemi-thyroidectomy. Design/Methods: the authors conduced an Italian multicentric retrospective analysis about pediatric patients suffering from DTC between 2000 and 2014. Medullary carcinomas have been excluded. A total of 259 patients underwent surgical treatment: conservative surgery (lobectomy associated to isthumesctomy) has been performed in low risk patients (neoplasm limited to one lobe, no extra-thyroidal spread, absence of distant metastasis) with a tumor < 2cm; the other patients have been treated by radical surgery. Results: total thyroidectomy has been performed in 235 (90.7%) patients whereas hemithyroidectomy in 24 (9.3%) patients. Post-surgical complications occurred in 57 patients (22%): 37 (14.3%) transitory hypocalcaemia (14.3%), 11 (4.2%) permanent hypocalcaemia, 7 (2.7%) laryngeal nerve injury with vocal cord palsy (5 ipsilateral, 2 bilateral), 2 (< 1%) cheloid scars. All post-surgical complications occurred after radical surgery. To date, all patients are alive (overall survival 100%); 30 patients (11.6%) had relapse, in average after 1.7 years: 29 after radical surgery and 1 after conservative surgery. Conclusion: the surgical treatment should be personalized and based on an accurate evaluation of the risk to choose the best surgical approach. Small tumors in low-risk pediatric patients can be treated by conservative surgery: our casuistry shows an excellent prognosis and this approach decreases drastically the rate of recurrence.
Differentiated thyroid carcinoma in childhood and adolescence: indication for conservative surgery. An italian multicentric study on 260 patients.
SPINELLI, CLAUDIO;
2015-01-01
Abstract
Background/Objectives: In the recent decades the incidence of pediatric differentiated thyroid carcinoma (DTC) increased. DTC in pediatric age is rare and has an excellent prognosis. Nevertheless, the best surgical treatment is unclear, and the debated focus on radical vs conservative surgery. Total thyroidectomy has a lower rate of recurrence but an higher risk of complications. Our study purposes to evaluate the long-term prognosis of pediatric patients who underwent surgical treatment for thyroid cancer, both by total thyroidectomy and hemi-thyroidectomy. Design/Methods: the authors conduced an Italian multicentric retrospective analysis about pediatric patients suffering from DTC between 2000 and 2014. Medullary carcinomas have been excluded. A total of 259 patients underwent surgical treatment: conservative surgery (lobectomy associated to isthumesctomy) has been performed in low risk patients (neoplasm limited to one lobe, no extra-thyroidal spread, absence of distant metastasis) with a tumor < 2cm; the other patients have been treated by radical surgery. Results: total thyroidectomy has been performed in 235 (90.7%) patients whereas hemithyroidectomy in 24 (9.3%) patients. Post-surgical complications occurred in 57 patients (22%): 37 (14.3%) transitory hypocalcaemia (14.3%), 11 (4.2%) permanent hypocalcaemia, 7 (2.7%) laryngeal nerve injury with vocal cord palsy (5 ipsilateral, 2 bilateral), 2 (< 1%) cheloid scars. All post-surgical complications occurred after radical surgery. To date, all patients are alive (overall survival 100%); 30 patients (11.6%) had relapse, in average after 1.7 years: 29 after radical surgery and 1 after conservative surgery. Conclusion: the surgical treatment should be personalized and based on an accurate evaluation of the risk to choose the best surgical approach. Small tumors in low-risk pediatric patients can be treated by conservative surgery: our casuistry shows an excellent prognosis and this approach decreases drastically the rate of recurrence.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
