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Surgical Treatment of Low- and Intermediate-Risk Papillary Thyroid Cancer with Minimally Invasive Video-Assisted Thyroidectomy

Departments of Surgery (P.M., G.M., P.B., P.F.) and Endocrinology and Metabolism (A.P., A.B., E.M., D.V., R.E.), University of Pisa, 56100 Pisa, Italy; and AMBISEN Center (A.P.), High Technology Center for the Study of the Environmental Damage of the Endocrine and Nervous Systems, University of Pisa, 56124 Pisa, Italy

Address all correspondence and requests for reprints to: P. Miccoli, M.D., Department of Surgery, University of Pisa, Via Roma 64, 56100 Pisa, Italy. E-mail: p.miccoli{at}dc.med.unipi.it.

Background: Minimally invasive video-assisted thyroidectomy (MIVAT) was introduced in the clinical practice to treat small benign thyroid nodules. This method has recently been demonstrated to produce the same completeness as a conventional thyroidectomy in patients with papillary thyroid cancer (PTC). The low number of treated cases and the limited follow-up of these patients represent the major limitations of these studies.

Objective: The aim of the study was to compare the outcome of two groups of PTC patients, one treated with MIVAT and the other with conventional thyroidectomy, after a median follow-up of 5 yr.

Study Group: A total of 221 PTC patients were enrolled in this study according to the following criteria: 171 were treated with MIVAT (group A), and 50 were treated with conventional thyroidectomy (group B).

Results: The outcome and the cumulative ¹³¹I activity administered to achieve curative status were compared. After a mean follow-up of 3.6 ± 1.5 yr (range, 1–8 yr; median, 5 yr), no differences were found between group A and group B. A similar rate of permanent hypoparathyroidism and/or nerve cord palsy was found in both groups.

Conclusion: We demonstrated that PTC patients operated on with MIVAT had a good outcome after 5 yr. This was similar to the outcome of patients treated with conventional thyroidectomy and the same degree of exposure to ¹³¹I. These results, together with the evidence of a similar degree of completeness and rate of complications between the two surgical techniques, show that MIVAT is a valid option to treat low- and intermediate-risk PTC patients.