Is isthmic enucleo-resection a reliable treatment for isthmic differentiated thyroid carcinoma? A note of caution
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Is isthmic enucleo‑resection a reliable treatment for isthmic differentiated thyroid carcinoma? A note of caution A. Campennì1 · R. Piantanida2 · L. Giovanella3,4 Received: 14 April 2020 / Accepted: 2 May 2020 © Italian Society of Endocrinology (SIE) 2020
Keywords Differentiated thyroid cancer · Isthmus · Thyroid surgery · Isthmusectomy · Lymph-node metastases 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, loboisthmectomy 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. The disease-specific survival was 100% independently from * A. Campennì [email protected] 1
Nuclear Medicine Unit, Department of Biomedical and Dental Sciences and Morpho‑Functional Imaging, University Hospital, University of Messina, Messina, Italy
2
Division of Otolaryngology and Cervico‑Facial Surgery, Ente Ospedaliero Cantonale, Lugano, Switzerland
3
Clinic for Nuclear Medicine and Thyroid Center, Imaging Institute of Southern Switzerland, Bellinzona, Switzerland
4
University Hospital, University of Zürich, Zurich, Switzerland
surgical procedures. The recurrence-free survival at 10-year was 93% in patients treated by isthmectomy and 94.6% in patients treated by lobectomy or thyroidectomy, respectively. Basing on such observation, isthmectomy was proposed as a reliable alternative to either lobectomy or thyroidectomy in selected patients with low- and intermediate-risk DTC limited to the isthmus. These results sound interesting, however, we have several comments and concerns regarding the study design and conclusions: • First, demographic, clinical and pathological characteris-
tics of patients treated with different surgical approaches are not provided. Compounded with the retrospective design of the study this omission make any comparison unreliable. • Second, the authors excluded from their analysis 3 pa
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