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Lobo-isthmectomy in the management of differentiated thyroid cancer

We have recently witnessed a rapid increase in the incidence of differentiated thyroid carcinoma (DTC), particularly low and very low-risk papillary thyroid carcinoma. Simultaneously, the number of cancer-related deaths has remained stable for more than 30 years. Such an indolent nature and long-ter...

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Autores principales: Krajewska, Jolanta, Kukulska, Aleksandra, Samborski, Konrad, Czarniecka, Agnieszka, Jarzab, Barbara
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9923929/
https://www.ncbi.nlm.nih.gov/pubmed/36775829
http://dx.doi.org/10.1186/s13044-022-00145-1
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author Krajewska, Jolanta
Kukulska, Aleksandra
Samborski, Konrad
Czarniecka, Agnieszka
Jarzab, Barbara
author_facet Krajewska, Jolanta
Kukulska, Aleksandra
Samborski, Konrad
Czarniecka, Agnieszka
Jarzab, Barbara
author_sort Krajewska, Jolanta
collection PubMed
description We have recently witnessed a rapid increase in the incidence of differentiated thyroid carcinoma (DTC), particularly low and very low-risk papillary thyroid carcinoma. Simultaneously, the number of cancer-related deaths has remained stable for more than 30 years. Such an indolent nature and long-term survival prompted researchers and experts to an ongoing discussion on the adequacy of DTC management to avoid, on the one hand, the overtreatment of low-risk cases and, on the other hand, the undertreatment of highly aggressive ones. The most recent guidelines of the American Thyroid Association (ATA GL) moved primary thyroid surgery in DTC towards a less aggressive approach by making lobectomy an option for patients with intrathyroidal low-risk DTC tumors up to 4 cm in diameter without evidence of extrathyroidal extension or lymph node metastases. It was one of the key changes in DTC management proposed by the ATA in 2015. Following the introduction of the 2015 ATA GL, the role of thyroid lobectomy in DTC management has slowly become increasingly important. The data coming from analyses of the large databases and retrospective studies prove that a less extensive surgical approach, even if in some reports it was related to a slight increase of the risk of recurrence, did not show a negative impact on disease-specific and overall survival in T1T2N0M0 low-risk DTC. There is no doubt that making thyroid lobectomy an option for low-risk papillary and follicular carcinomas was an essential step toward the de-escalation of treatment in thyroid carcinoma. This review summarizes the current recommendations and evidence-based data supporting the necessity of de-escalation of primary thyroid surgery in low-risk DTC. It also discusses the controversies raised by introducing new ATA guidelines and tries to resolve some open questions.
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spelling pubmed-99239292023-02-14 Lobo-isthmectomy in the management of differentiated thyroid cancer Krajewska, Jolanta Kukulska, Aleksandra Samborski, Konrad Czarniecka, Agnieszka Jarzab, Barbara Thyroid Res Review We have recently witnessed a rapid increase in the incidence of differentiated thyroid carcinoma (DTC), particularly low and very low-risk papillary thyroid carcinoma. Simultaneously, the number of cancer-related deaths has remained stable for more than 30 years. Such an indolent nature and long-term survival prompted researchers and experts to an ongoing discussion on the adequacy of DTC management to avoid, on the one hand, the overtreatment of low-risk cases and, on the other hand, the undertreatment of highly aggressive ones. The most recent guidelines of the American Thyroid Association (ATA GL) moved primary thyroid surgery in DTC towards a less aggressive approach by making lobectomy an option for patients with intrathyroidal low-risk DTC tumors up to 4 cm in diameter without evidence of extrathyroidal extension or lymph node metastases. It was one of the key changes in DTC management proposed by the ATA in 2015. Following the introduction of the 2015 ATA GL, the role of thyroid lobectomy in DTC management has slowly become increasingly important. The data coming from analyses of the large databases and retrospective studies prove that a less extensive surgical approach, even if in some reports it was related to a slight increase of the risk of recurrence, did not show a negative impact on disease-specific and overall survival in T1T2N0M0 low-risk DTC. There is no doubt that making thyroid lobectomy an option for low-risk papillary and follicular carcinomas was an essential step toward the de-escalation of treatment in thyroid carcinoma. This review summarizes the current recommendations and evidence-based data supporting the necessity of de-escalation of primary thyroid surgery in low-risk DTC. It also discusses the controversies raised by introducing new ATA guidelines and tries to resolve some open questions. BioMed Central 2023-02-13 /pmc/articles/PMC9923929/ /pubmed/36775829 http://dx.doi.org/10.1186/s13044-022-00145-1 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Review
Krajewska, Jolanta
Kukulska, Aleksandra
Samborski, Konrad
Czarniecka, Agnieszka
Jarzab, Barbara
Lobo-isthmectomy in the management of differentiated thyroid cancer
title Lobo-isthmectomy in the management of differentiated thyroid cancer
title_full Lobo-isthmectomy in the management of differentiated thyroid cancer
title_fullStr Lobo-isthmectomy in the management of differentiated thyroid cancer
title_full_unstemmed Lobo-isthmectomy in the management of differentiated thyroid cancer
title_short Lobo-isthmectomy in the management of differentiated thyroid cancer
title_sort lobo-isthmectomy in the management of differentiated thyroid cancer
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9923929/
https://www.ncbi.nlm.nih.gov/pubmed/36775829
http://dx.doi.org/10.1186/s13044-022-00145-1
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