title: The role of a more extensive surgical approach in the initial multimodality management of papillary thyroid cancer in children.
abstract: OBJECTIVE
  Papillary thyroid cancer (PTC) in children is rare. The optimal initial surgical treatment remains controversial, given the generally favorable overall prognosis but high rate of cervical metastasis and local recurrence. Our objective was to examine the surgical outcomes of a policy of total thyroidectomy and routine selective lymph node dissection (SLND) as the initial surgical approach to children with PTC.
  
  
  METHODS
  This is a retrospective cohort study comprising 14 children (age, < or =17 years) with PTC referred for thyroid surgery during the past 15 years. Clinical presentation, the surgical procedure, final pathology, lymph node involvement, complications, and recurrence rates are reported.
  
  
  RESULTS
  There were 9 females and 5 males, with an average age of 12.5 years. Seven patients (50%) had clinically apparent cervical lymphadenopathy at the time of surgical referral. All subjects underwent total thyroidectomy, and 12 (86%) had SLND. Of the 12 who underwent SLND, 10 (83%) had nodal metastases. Temporary hypocalcemia was noted in 3 of the patients (21%), and 1 patient has required ongoing intermittent calcium supplementation. All patients are alive and well at follow-up with no clinical, biochemical, or radiological evidence of local recurrence.
  
  
  CONCLUSIONS
  Total thyroidectomy with initial SLND is an appropriate surgical approach in children with PTC. It can be done without a significantly increased risk for permanent complications and may reduce the requirement for subsequent surgical intervention for local recurrence in this young population.
authors.affiliation: University of Sydney Endocrine Surgical Unit, Department of Surgery, Royal North Shore Hospital, Sydney, NSW, 2065, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Savio
authors.forename: Jessica
authors.initials: J
authors.lastname: Gosnell
authors.forename: F Fausto
authors.initials: FF
authors.lastname: Palazzo
authors.forename: Mark
authors.initials: M
authors.lastname: Sywak
authors.forename: Gaurav
authors.initials: G
authors.lastname: Agarwal
authors.forename: Chris
authors.initials: C
authors.lastname: Cowell
authors.forename: Albert
authors.initials: A
authors.lastname: Shun
authors.forename: Bruce
authors.initials: B
authors.lastname: Robinson
authors.forename: Leigh W
authors.initials: LW
authors.lastname: Delbridge
mesh_terms: D000293:Adolescent; D002291:Carcinoma, Papillary / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D012189:Retrospective Studies; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy