Is isthmic enucleo-resection a reliable treatment for isthmic differentiated thyroid carcinoma? A note of caution

摘要

Differentiated thyroid cancer (DTC) is the most frequent endocrine cancer and its incidence has been increasing over time, with a large prevalence of small tumors in female patients. In general, DTC patients have a good prognosis and, in this light, the optimal initial surgical approach for most DTC is still largely debated. Lobectomy is currently proposed as an alternative to (near)-total thyroidectomy in low-risk DTC [1, 2] with a large debate still ongoing, especially for tumors >20 mm [3, 4]. Recently, Park and colleagues [5] published in Head and Neck (2020) an original paper in which they carried out a retrospective analysis on a large cohort of patients (n = 6259) treated from 1986 to 2015 in a single tertiary care cancer center. They selected patients with low- and intermediate-risk tumor (according to the 2015 American Thyroid Association guidelines) limited to the isthmus and no suspicious lymph nodes at preoperative ultrasound (cN0) treated with either thyroidectomy, lobo-isthmectomy or isthmectomy alone. Overall, 220 (3.5%) patients were included; among them 14 (6.4%) patients had thyroid lobectomy with isthmusectomy, 161 (73.2%) patients had total thyroidectomy, 2 (0.9%) patients had subtotal thyroidectomy, and 43 (19.5%) patients had isthmusectomy alone. The latters were reported and analyzed by the authors.