Surgical management of papillary thyroid carcinoma in childhood and adolescence: an Italian multicenter study on 250 patients

C. Spinelli, S. Strambi, L. Rossi, S. Bakkar, Maura Massimino, Andrea Ferrari, Paola Collini, Giovanni Cecchetto, Gianni Bisogno, Alessandro Inserra, F. Bianco, Paolo Miccoli

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)1055-1059
Number of pages5
JournalJournal of Endocrinological Investigation
Volume39
Issue number9
DOIs
Publication statusPublished - Sep 1 2016

Keywords

  • Conservative surgery
  • Papillary thyroid carcinoma
  • Pediatric thyroid cancer
  • Total thyroidectomy

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

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