Thyroid Isthmusectomy for Micropapillary Cancer: Fourth Option for Micropapillary Ca?
1. 55 Y/O female presented S/P removal of JUST her isthmus for a micropapillary cancer. She had a central neck scar from the surgery.
In 46 years of thyroid practice this is the first of my patients treated with this banned procedure.
2. She was not given all the usual options for a MPTC of surgery, active surveillance AS of Radiofrequency ablation RFA.
3. The surgeon failed to tell her that she could have the micro pap ablated and saved the surgery which even for just the isthmus required
hospital and a general anesthesia.
4. Also the next best option to that surgery would be AS.
5. “The American Thyroid Association guidelines do not mention isthmusectomy as an appropriate procedure for thyroid cancer.”
6. 19/1,810 (1 % ) patients were managed by isthmus only removal at Memorial Sloan Kettering Cancer Center from 1986-2005.
7. All 19 were before the new alternative treatments of RFA and Active surveillance.
8. If another study from 2010-2020 were done it is highly unlikely there would be any of these surgeries being done.
9. My patient had an 11 mm isthmus cancer with good preserved normal tissue around it.
10. A surgeon at a major top ten university who appears to be hard up for patients and did not want to lose this case to a RFA interventional thyroidologist or endocrinologist to follow her during active surveillance.
11. Shame of surgeons who fail to inform their referral physicians and the patient that in 2020 isthmusectomy is not an appropriate procedure for thyroid cancer.
12. Since FDA approval of soft tissue use of RFA for thyroid nodules, recurrent neck lymph node metastatic disease and micro papillary cancers we are treating many with RFA.
13. My patient was shocked that RFA was not mentioned as an option.
14. She had refused thyroidectomy and active surveillance and felt her only option to keep her thyroid was this rare surgery.
15. Alert to all patients with small papillary thyroid cancer. Do your homework before settling on surgery. Go outside to get expert opinions on AS and RFA for your cancer.
Ask for Alicia.
Thyroid isthmusectomy for well-differentiated thyroid cancer
Background: The American Thyroid Association guidelines do not mention isthmusectomy as an appropriate procedure for thyroid cancer. Despite this, a small number of patients present with lesions isolated to the thyroid isthmus, which can be excised without exploring the trachyesophageal grooves or total thyroidectomy. This study was designed to analyze outcomes in patients treated with isthmusectomy for small well-differentiated thyroid cancer (WDTC) at our institution.
Methods: Nineteen patients with WDTC managed by isthmusectomy were identified from a database of 1,810 patients (1%) with WDTC managed by surgery in Memorial Sloan Kettering Cancer Center from 1986-2005. Demographic, surgical, pathological, and outcomes data were analyzed.
Results: Six patients were men and 13 were women. The median age was 46 (range, 28-83) years. All patients had a solitary nodule confined to the thyroid isthmus. The median size of lesion was 1 (range, 0.4-3) cm. Eighteen patients had a pathologically T1 lesion (pT1), and one patient had a pT2 lesion. Two patients had papillary carcinoma detected in perithyroid lymph nodes (pN1a). There were no complications of recurrent laryngeal nerve palsy or hypocalcaemia. With a median follow-up of 124 (range, 53-276) months, the 10-year disease-specific survival was 100% and 100% local and regional 10-year recurrence-free survival.
Conclusions: Our results suggest that isthmusectomy alone may be sufficient treatment for selected patients with small WDTC limited to the isthmus. This procedure has the benefit of avoiding dissection of the recurrent laryngeal nerve and parathyroid glands, thus limiting postoperative complications.