Clinical Outcomes after Delayed Thyroid Surgical Operation in Patients with Papillary Thyroid Microcarcinoma
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- Category: Vol. 89, December 2021
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Clinical Outcomes after Delayed Thyroid Surgical Operation in Patients with Papillary Thyroid Microcarcinoma, ESLAM T. GHALWASH
Abstract
Background: Papillary carcinoma is the commonest his-tologicalkind of malignancies sheltering from the thyroid gland. Lately, the extensive usage of ultrasonography (US) and US-driven fine needle aspiration cytology (FNAC) has sturdily facilitated the pre-operative detections and diagnosing of small papillary carcinomas 1.0cm in utmostsize. Thyroid operation was the present standard management for PTMC. Given the sluggish behaviors and advantageous prognosing of low-risk PTMC, operation can cause more harm than advantage, owing to some permanent side effects, cosmetic complications, and life-long thyroid hormone replacements. Aim of Study: To assess long term outcome of delayed thyroid surgical operation after papillary thyroid microcarci-noma (BTMC) and to assess the disease-free survival (DFS) rate among group I without clinically apparent LNM and group II with LNM. To compare between both groups regarding DFS. Patients and Methods: This prospective research was performed in From Jan. 2014 to Dec. 2020, 735 cases who experienced delayed thyroid operation (entire or near-entire thyroidectomy) after at least 3 months with or without neck lymph node dissection (LND) trailed by radioactive-iodine treatment. After follow-up and fulfilling the criteria the final sample size was 420 patients who continued the study. Consequently, we assumed our cases allocated into 2 groups imitating initial certain interventions Group I: Cases with low-risk PTMC without LNM who underwent lobectomy with prophylactic CCND (n=330) and Group II: Cases with low-risk PTMC excluding clinically apparent LNM who experience dentire thyroidectomy with MRND (n=90). Results: Upon comparing basic characteristics, the mean age was 48.3±7.2 and 44.6±6.6 years among group 1 and 2 respectively. There were 62.4% and 64.4% males among group 1 and 2 respectively. There were 23.6% and 54.4% had extra thyroid extension among group 1 and 2. Group 2 with higher significant ETE percentage. The mean following-up interval was 45.5±12.8 months and 37.6±9.9 months among group 1 and 2 respectively. Group 1 had significant higher follow-up period than group 2. Regarding the characteristics of the tumor, the mean cancer volume was 0.35±0.1cm and 0.47±0.2cm among group 1 and 2 respectively. Group 2 was higher significantly than group 1. There were 60% T1 among group 1 while 62.2% T3 among group 2 with significant difference among both groups. There were 81.8% N0 among group 1 and 100% N1b among group 2 with significant difference between both groups. There were 75.2% and 56.7% stage I among group 1 and 2 resp. with significant changea-mong both groups. There were 1.1% had distant metastasis among group 2. Group 2 was higher significantly than group 1 regarding recurrence, distant metastasis and death. By means of the Kaplan-Meier technique, we revealed that 7-years diseases free survival rate was significantly dissimilar among both Groups by Log rank testing (p-value<0.001). Conclusion: In conclusion, a significant change was found among group without LNM and group with LNM regarding recurrence, distant metastasis, and disease specific death. In comparison between two groups regarding DFS rates, there was significant change by Log rank test (p<0.001).