Extensive surgery improves recurrence-free survival for children and youngpatients with class I papillary thyroid carcinoma

Background: Children with papillary thyroid cancer (PTC) rarely die of thei r disease, but are at high risk for recurrence, particularly with multifoca l tumors (which occur in 42% of children with PTC). It is not clear if more extensive surgery, with an increased risk of complications, lessens the ri sk for recurrence. The authors hypothesized that patients with disease pres umed to be confined to the thyroid gland (class I PTC) could have multifoca l disease, involving the contralateral lobe, of which the surgeon is unawar e. Treatment with less than subtotal thyroidectomy might be associated with a higher risk of recurrence. Methods: The charts of 37 patients with Class I PTC diagnosed at less than or equal to 21 years of age between 1953 and 1996 were reviewed. The incide nce of surgical complications and the risk of recurrence based on the exten t of initial surgery ([1] lobectomy with or without isthmusectomy, [2] subt otal, or [3] total thyroidectomy) and adjunctive therapy with thyroid hormo ne or radioactive iodine (RAI) were examined. Results: Eight patients had recurrent PTC. Patients treated with lobectomy with or without isthmusectomy were more likely to have recurrence than pati ents treated with subtotal or total thyroidectomy (Odds ratio, 8.7; 95% CI 1.4 to 54). Although the incidence of complications was statistically simil ar among the 3 surgical groups, 3 patients, all treated with more extensive surgery, had permanent hypoparathyroidism. There were too few patients to determine whether treatment with thyroid hormone or RAI offered additional benefit. Conclusions: In children with Class I PTC, more extensive surgery is associ ated with a lower risk of recurrence. This finding must be weighed against the risk of complications when determining the optimal treatment for indivi dual patients. J Pediatr Surg 34:1799-1804. Copyright (C) 1999 by W.B. Saun ders Company.