title: Controversies in the surgical management of thyroid follicular neoplasms. Retrospective analysis of 721 patients.
abstract: The most appropriate surgical management of "follicular neoplasm/suspicious for follicular neoplasm" lesions, is still controversial. Analysing and comparing the experience of two units for endocrine surgery, we retrospectively evaluated 721 patients, surgically treated after a follicular neoplasm diagnosis. Total thyroidectomy was routinely performed in one Institution, while in the other one it was selectively carried out. The main criteria leading to hemythyroidectomy were a single nodule, the age ≤45 years, the absence of thyroiditis or clinical/intraoperative suspicion of malignancy. Total thyroidectomy was performed in 402/721 patients (55.7%), hemythyroidectomy in 319/721 cases (44.2%) and a completion thyroidectomy in 51/319 cases (15.9%). The overall malignancy rate was 24% (176/721 patients), respectively 16% (51/319 patients) following hemythyroidectomy, and 31% (125/402 patients) following total thyroidectomy. Definitive recurrent laryngeal nerve paralysis and permanent hypoparathyroidism were not reported in hemythyroidectomy patients in which lower mean hospitalization and costs were observed. Considering the low-risk of follicular neoplasm solitary lesions, hemythyroidectomy is still the safest standard of care with lower hospitalization and costs. In case of multiglandular disease or thyroiditis, that might be associated with a higher risk of cancer, total thyroidectomy should be recommended. Further investigation is warranted to achieve a better preoperative follicular neoplasm diagnostic accuracy in order to reduce the amount of unnecessary surgical operations with a diagnostic aim.
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, VII Division of General and Endocrine Surgery, Second University of Naples, Via Gen. G. Orsini 42, 80132 Napoli, Italy. Electronic address: giovanni.conzo@unina2.it.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Conzo
authors.affiliation: Department of Surgical Sciences University of Cagliari, Italy.
authors.forename: Pietro Giorgio
authors.initials: PG
authors.lastname: Calò
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, VII Division of General and Endocrine Surgery, Second University of Naples, Via Gen. G. Orsini 42, 80132 Napoli, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Gambardella
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, VII Division of General and Endocrine Surgery, Second University of Naples, Via Gen. G. Orsini 42, 80132 Napoli, Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Tartaglia
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, VII Division of General and Endocrine Surgery, Second University of Naples, Via Gen. G. Orsini 42, 80132 Napoli, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Mauriello
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, VII Division of General and Endocrine Surgery, Second University of Naples, Via Gen. G. Orsini 42, 80132 Napoli, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Della Pietra
authors.affiliation: Department of Surgical Sciences University of Cagliari, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Medas
authors.affiliation: Department of Surgical Sciences University of Cagliari, Italy.
authors.forename: Rosa
authors.initials: R
authors.lastname: Santa Cruz
authors.affiliation: Department of Surgical Sciences University of Cagliari, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Podda
authors.affiliation: Department of Anesthesiologic, Surgical and Emergency Sciences, VII Division of General and Endocrine Surgery, Second University of Naples, Via Gen. G. Orsini 42, 80132 Napoli, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Santini
authors.affiliation: Department of Biomorphologic and Functional Sciences, "Federico II" University of Naples, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Troncone
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D019564:Unnecessary Procedures; D014826:Vocal Cord Paralysis / Q000209:etiology; D055815:Young Adult
keywords: Fine needle cytology; Follicular neoplasm; Hemithyroidectomy; Thyroid cancer; Total thyroidectomy