Surgery News - December 2008 - (Page 13) DECEMBER 2008 • SURGERY NEWS ENDOCRINE SYSTEM 13 Total Thyroidectomy Best for Micropapillary Thyroid Ca BY BRUCE JANCIN Else vier Global Medical Ne ws C H I C A G O — Patients with multifocal micropapillary thyroid cancer who received less than a near-total thyroidectomy had a threefold higher recurrence rate in a National Thyroid Cancer Treatment Cooperative Study Group investigation. “Our data support the need for near-total or total thyroidectomy in patients with multifocal micropapillary thyroid carcinoma,” Dr. Douglas S. Ross said at the annual meeting of the American Thyroid Association. The jury remains out, however, on the merits of adjunctive radioactive iodine (RAI) in patients with micropapillary thyroid cancer (MPTC). Adjunctive RAI didn’t affect recurrence rates in patients with multifocal or node-positive MPTC in this study, and those with unifocal disease who got RAI actually had more recurrences than those who didn’t. But this wasn’t a randomized trial, and it’s likely that selection bias was at work. “There’s also the The jury remains possibility that RAI out on the merits may enhance the of adjunctive RAI ability to detect rein patients with currences earlier,” micropapillary observed Dr. Ross thyroid cancer. of Massachusetts DR. ROSS General Hospital and Harvard Medical School, Boston. The National Thyroid Cancer Treatment Cooperative Study Group comprises 11 North American medical centers which enrolled 4,830 thyroid cancer patients in a prospective registry during 19872006. MPTC was present in 710. Dr. Ross’ analysis focused on the 611 who had intrathyroid MPTC, had no distant metastases, and were disease free after initial treatment. Nearly 80% were women, and 45% were under age 45 years. Multifocal disease was present in 38% and nodal metastases in 22%. Participants were followed for a median of 4 years. During 2,572 person-years of follow-up, 38 patients (6.2%) were diagnosed with recurrences. The recurrences were detected a mean of 2.8 years after primary therapy, with a range of 6 months to 11 years. In all, 37% of recurrences were regional, 45% occurred in the remnant thyroid bed, and there was a single distant metastasis. One thyroid cancer death occurred. The overall recurrence rate didn’t differ between patients with unifocal and multifocal disease. However, 4 of 22 patients (18%) with multifocal disease who received less than a near-total thyroidectomy had a recurrence, vs. 16 of 263 (6%) with unifo- cal disease who had similarly limited surgery. In the multifocal MPTC group, the recurrence rate was 6% in those who got near-total or total thyroidectomy, vs. 18% with less than near-total thyroidectomy. Recurrent disease was detected a mean of 2.3 years following primary therapy in patients who got RAI and 4.4 years in those who did not. Among individuals who didn’t receive RAI, the recurrence rate was 7% in those with multifocal disease and 2% in those with unifocal MPTC. But it’s likely that most patients who got adjunctive RAI had more adverse pathologic features than those who didn’t. The reported incidence of thyroid cancer has more than doubled in the last several decades, yet the death rate attributable to the malignancy hasn’t changed. The explanation for this phenomenon is thought to lie in the sharp increase in MPTCs detected incidentally using modern imaging methods. The mortality rate of MPTC is very low, but controversy surrounds the best form of surgery and the role of RAI. ■ Time to Recurrent Disease After Primary Therapy 4.4 years 2.3 years The test isn’t real. The security is. Find real confidence in 5mm clip security with LIGAMAX™ 5. ELSEVIER GLOBAL MEDICAL NEWS Adjunctive radioactive iodine No radioactive iodine The LIGAMAX™ 5 clip applier delivers the same secure Medium/Large clips you get from a 10mm applier, but in a slimmer, more versatile 5mm size. For more information, visit www.LIGAMAX5.com, or call for a demo at 1-800-USE-ENDO. © 2008 Ethicon Endo-Surgery DSL#08-0366.H Note: Based on data from 38 patients with recurrences. Source: Dr. Ross http://www.ligamaX5.com http://www.ligamaX5.com
Table of Contents Feed for the Digital Edition of Surgery News - December 2008 Surgery News - December 2008 Contents The 20/20 Vision: Health Reform News From the College: Nominations Thoracic: Breathing Easier Postop Management: Renal Failure Surgery News - December 2008 Surgery News - December 2008 - Contents (Page 1) Surgery News - December 2008 - Contents (Page 2) Surgery News - December 2008 - Contents (Page 3) Surgery News - December 2008 - Contents (Page 4) Surgery News - December 2008 - Contents (Page 5) Surgery News - December 2008 - The 20/20 Vision: Health Reform (Page 6) Surgery News - December 2008 - The 20/20 Vision: Health Reform (Page 7) Surgery News - December 2008 - The 20/20 Vision: Health Reform (Page 8) Surgery News - December 2008 - The 20/20 Vision: Health Reform (Page 9) Surgery News - December 2008 - News From the College: Nominations (Page 10) Surgery News - December 2008 - News From the College: Nominations (Page 11) Surgery News - December 2008 - Thoracic: Breathing Easier (Page 12) Surgery News - December 2008 - Thoracic: Breathing Easier (Page 13) Surgery News - December 2008 - Thoracic: Breathing Easier (Page 14) Surgery News - December 2008 - Thoracic: Breathing Easier (Page 15) Surgery News - December 2008 - Postop Management: Renal Failure (Page 16) Surgery News - December 2008 - Postop Management: Renal Failure (Page 17) Surgery News - December 2008 - Postop Management: Renal Failure (Page 18) Surgery News - December 2008 - Postop Management: Renal Failure (Page 19) Surgery News - December 2008 - Postop Management: Renal Failure (Page 20)
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