Video-Assisted Thyroidectomy for Papillary Thyroid Carcinoma: Oncologic Outcome in Patients with Follow-Up\ua0 65\ua010 Years

Background: Video-assisted thyroidectomy (VAT) arisen as a valid treatment for selected patients with papillary thyroid carcinoma (PTC), but no data concerning long-term oncologic outcome are available. The primary aim of the study was to evaluate the oncologic outcome of patients who underwent VAT for PTC with a follow-up\ua0 65\ua010\ua0years. Methods: The medical charts of all the patients who successfully underwent VAT for PTC were reviewed. The patients with a minimum follow-up period of 120-months were included. Patients with unifocal PTC\ua0 64\ua01\ua0cm, in the absence of lymph node metastases, without gross extracapsular invasion and age\ua0<\ua045\ua0years were considered \u201clow-risk\u201d patients and followed with ultrasound and serum thyroglobulin (sTg) on levothyroxine (LT4); the remaining patients underwent nuclear medicine evaluation. Results: Two hundred and fifty-seven patients, operated on between May 2000 and October 2006, were included. Postoperative complications included four transient recurrent palsies, 76 transient and 1 permanent hypocalcemia. One hundred and four low-risk patients were followed with ultrasound and sTg on LT4. At a mean follow-up of 136.6\ua0months, mean sTg on LT4 was 0.1\ua0\ub1\ua00.1\ua0ng/ml. None of them showed recurrence. The remaining 153 patients underwent nuclear medicine evaluation. Among these 153, 62 did not undergo radioiodine ablation (RAI). At a mean follow-up of 150.8\ua0months, mean sTg on LT4 was 0.1\ua0\ub1\ua00.1\ua0ng/ml. None of them showed recurrence. The remaining 91 patients underwent RAI. Mean pre-RAI sTg off-LT4 was 8.3\ua0\ub1\ua05.8\ua0ng/ml, mean radioiodine uptake was 2.8\ua0\ub1\ua04.4%. Among these 91, three pN1a patients developed a lateral neck node recurrence. No other recurrence was registered. At the latest follow-up mean sTg on LT4 in this subgroup of patients was 0.1\ua0\ub1\ua00.2\ua0ng/ml. Conclusions: The long-term ( 65\ua010\ua0years) oncologic outcome further demonstrates that VAT is a valid option for selected PTC patients