title: Surgical management of papillary thyroid carcinoma in childhood and adolescence: an Italian multicenter study on 250 patients.
abstract: OBJECTIVE
  The extent of surgery for pediatric papillary thyroid carcinoma is debatable. The aim of this study was to evaluate the feasibility of offering pediatric patients a tailored surgical approach based on certain clinical features.
  
  
  METHODS
  A national multicenter retrospective review of 250 pediatric patients treated for papillary thyroid carcinoma in a 14-year period was performed. Outcomes of interest included tumor-related features, type of surgery, surgical morbidity, disease-free and overall survival rates. Recurrence was thoroughly analyzed with particular focus on how it correlated with certain patient- and tumor-related features.
  
  
  RESULTS
  The majority of patients (58.8 %) had tumors >2 cm in size. Nodal involvement occurred in 115/250 (46 %) patients and distant metastasis in 4 % (10/250). Total thyroidectomy and lobectomy were performed in 90.4 % (226/250) and 9.6 % (24/250) of patients, respectively. The overall rate of surgical complications was 20.8 % (52/250). These included transient and permanent hypoparathyroidism (13.6 and 4.4 %, respectively), and vocal fold palsy (2.8 %). All surgical complications occurred exclusively in the total thyroidectomy group. The rate of recurrent disease was 12 % (30/250) with the vast majority of recurrences (96.6 %) occurring in the total thyroidectomy group. The risk of recurrence correlated significantly with certain tumor-related features (size > 2 cm, multifocality, extrathyroidal invasion, nodal positivity, and distant metastasis). However, it did not correlate with the patient's age or sex. Overall survival was 100 %.
  
  
  CONCLUSIONS
  Pediatric patients are likely to benefit from a tailored surgical strategy. Uniformly offering patients total thyroidectomy seems to be an overly radical approach.
authors.affiliation: Division of Surgery, Department of Surgical Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy. c.spinelli@dc.med.unipi.it.
authors.forename: C
authors.initials: C
authors.lastname: Spinelli
authors.affiliation: Division of Surgery, Department of Surgical Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Strambi
authors.affiliation: Division of Surgery, Department of Surgical Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Rossi
authors.affiliation: Division of Surgery, Department of Surgical Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Bakkar
authors.affiliation: Pediatric Oncology Unit, Istituto Nazionale Tumori, University of Milan, Milan, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Massimino
authors.affiliation: Pediatric Oncology Unit, Istituto Nazionale Tumori, University of Milan, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ferrari
authors.affiliation: Department of Diagnostic Pathology and Laboratory Medicine, Istituto Nazionale Tumori, University of Milan, Milan, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Collini
authors.affiliation: Department of Women's and Children's Health, Pediatric Surgery Unit, University Hospital of Padua, Padua, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Cecchetto
authors.affiliation: Hematology-Oncology Division, Department of Pediatrics, Padova University Hospital of Padua, Padua, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Bisogno
authors.affiliation: Division of Pediatric Surgery, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Inserra
authors.affiliation: Faculty of Mathematical, Physical and Natural Sciences, University of Pisa, Pisa, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Bianco
authors.affiliation: Division of Surgery, Department of Surgical Pathology, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Miccoli
mesh_terms: D000293:Adolescent; D002291:Carcinoma, Papillary / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000601:surgery*; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000601:surgery*; D013965:Thyroidectomy
keywords: Conservative surgery; Papillary thyroid carcinoma; Pediatric thyroid cancer; Total thyroidectomy