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Program Number: AHNS30
Session Name: Scientific Session 6 - Endocrine
Session Date: Thursday, May 15, 2025
Session Time: 1:00 PM - 1:45 PM

Is thyroid lobectomy plus neck dissection an effective treatment option in select patients with N1b papillary thyroid carcinoma?

Daniel W Scholfield; Alana Eagan; Fergal Kavanagh; Giovanna Caxeiro; Helena Levyn; R M Tuttle; Richard J Wong; Jatin P Shah; Ashok R Shaha; Snehal G Patel; Ian Ganly; Memorial Sloan Kettering Cancer Center

Introduction: Total thyroidectomy (TT) plus neck dissection (ND) is typically employed in the management of papillary thyroid carcinoma (PTC) with lateral (N1b) neck metastases, in anticipation of need for adjuvant radioactive iodine (RAI) ablation. Thyroid Lobectomy (TL) plus ND is commonly practiced in Japan with excellent outcomes, however data from the US or Europe is lacking. The objectives of this study were therefore to compare recurrence and survival outcomes in propensity matched TL and TT patients who presented with N1b PTC at a tertiary cancer center in the United States.

Methods: After IRB approval, patients with N1b PTC treated at a US tertiary cancer center between 1986 and 2020 were identified from a prospectively maintained thyroid cancer database. 668 patients who underwent TT + lateral ND (LND) +/- central neck dissection (CND) and 37 patients who underwent TL + unilateral LND +/- CND without completion thyroidectomy were identified. Patients with distant metastases at presentation were excluded. Propensity score (PS) matching was undertaken to match patients on age, sex, PTC subtype, T stage, N stage, neck dissection and length of follow-up. Kaplan-Meier and logrank test were used to compare outcomes. Median follow-up was 113 months in the TL group and 159 months in the TT group.

Results: 37 eligible TL patients were identified. 76% (28/37) of TLs were undertaken between 1986 and 2000, and 24% (9/37) between 2000 and 2020.  71% (26/37) of TL patients were T1a/b, 14% (5/37) T2, 10.8% (4/37) T3a/b and 5.4% (2/37) T4a. Nodal disease in the TL group was low volume - the median number of positive lateral lymph nodes was 3, and the median metastatic lymph node size was 1.6cm. 37 TL patients were propensity matched to 37 TT patients. There was no significant difference between TL and TT in overall survival (10-year: 96.9% vs 93%, p = 0.14), disease specific survival (10-year: 96.7% vs 100%, p = 0.14; Figure 1) or recurrence free survival probability (10-year: 89.8% vs 84.7%, p = 0.52; Figure 2). There was no significant difference in local, regional, or distant recurrence free survival probability between the matched cohorts (p > 0.24).

Conclusion: Survival and recurrence outcomes are equivalent when comparing TT and TL in patients with N1b PTC in our study. This supports the experience of centers in Japan and suggests TL + ND is a safe and effective alternative to TT + ND in select patients with unifocal tumor confined to one lobe in low-risk PTC. This data has clinical utility in avoiding the need for lifelong thyroid hormone replacement and counselling patients who decline TT.

 

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