[Total thyroidectomy of choice in papillary microcarcinoma].
BACKGROUND
Today, the "gold standard" of surgical management of benign thyroid disease is still controversy. There are different surgical approaches to the thyroid gland, from a radical, total thyroidectomy to a conservative treatment, lobectomy with or not isthmectomy. In consideration of the more frequent incidence of small carcinomas accidentally founded in the context of the thyroid parenchyma removed for another pathology, the aim of this study is to bring a contribute to resolve the debate on the therapeutic choice in the surgical management of the thyroid benign disease.


METHODS
From January 2000 to January 2006 502 thyroidectomy were performed in the Section of General and Thoracic Surgery of University of Palermo: 458 total thyroidectomy (91.3%), 2 partial thyroidectomy (0.3%), 24 (4.8%) lobectomy with isthmectomy and 18 (3.6%) reinterventions for relapse; 34 patients (6.8%) were preoperative suspected (cytological or ultrasonography) for thyroid cancer.


RESULTS
After total thyroidectomy in 17 patients (3.4%) we founded a papillary incidental "microcarcinoma", diameter range 2-10 mm (mean 6.9 mm). In 2 cases (11.7%) we found infiltrative and multifocal tendency. Histologically, were 11 cases of classical papillary (64.7%), 4 cases (23.6%) of follicular and 2 (11.7%) sclerosing, in 9 cases of multinodular goiter, 3 of follicular adenoma, 3 cases of follicular carcinoma, 1 case of Graves disease and 1 case of Hashimoto thyroiditis.


CONCLUSIONS
Papillary microcarcinoma is a "thyroid papillary cancer with a diameter < or = 1 cm?". From the analysis of literature, we observed a progressive increasing of papillary microcarcinoma from 12% (1980) to 25% (1990), with a prevalence of diameters < or = 5. Actually, there are no univocal data on natural history, nodal metastasis, biological and clinical behaviour, morbidity and mortality of these neoplasms; the certain data is that only the radical surgery can prevent relapse and incidentalomas that modify surgical approach.


CONCLUSIONS
In our opinion, the surgical management of the all thyroid disease must be the more radical since the first time, because we think other approaches not correct to improve the complete health from the benign thyroid disease and to prevent (secondary prevention) papillary microcarcinoma not pre-operative diagnosed, because there are no preoperative pattern to make a correct diagnosis of this tumour.
Pisello
F
F
Università degli Studi di Palermo, Sezione di Chirurgia Generale ad Indirizzo Toracico, Italy.
Geraci
G
G
Sciumè
C
C
Li Volsi
F
F
Modica
G
G
D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012802:Sicily / Q000453:epidemiology; D013964:Thyroid Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome