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There are two management options for low-risk papillary thyroid microcarcinoma (PTMC), namely, active surveillance (AS) or immediate surgery (IS). Both have shown good long-term oncological outcomes. In a comparable retrospective study of 5646 patients at Kuma Hospital, 10- and 20-year lymph node metastasis appearance/recurrence rates were very low, at 1.1% and 1.7% in the AS group and 0.4% and 0.7% in the IS group, respectively. Ten- and 20-year tumor enlargement rates in the AS group were 4.7% and 6.6%, respectively. The incidences of unfavorable events, such as permanent vocal cord paralysis and hypoparathyroidism, were much higher in the IS group than in the AS group. A portion of patients underwent conversion surgery (CS) due to disease progression and other various reasons, and the postoperative recurrence rate did not differ between the CS and the IS groups. Taken together, AS is appropriate as the initial management for PTMC patients.

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Surgery Versus Active Surveillance for Papillary Thyroid Microcarcinoma

  • 章节

  • 发表日期：

    2025年

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  • Yasuhiro Ito,
  • Akira Miyauchi

摘要

There are two management options for low-risk papillary thyroid microcarcinoma (PTMC), namely, active surveillance (AS) or immediate surgery (IS). Both have shown good long-term oncological outcomes. In a comparable retrospective study of 5646 patients at Kuma Hospital, 10- and 20-year lymph node metastasis appearance/recurrence rates were very low, at 1.1% and 1.7% in the AS group and 0.4% and 0.7% in the IS group, respectively. Ten- and 20-year tumor enlargement rates in the AS group were 4.7% and 6.6%, respectively. The incidences of unfavorable events, such as permanent vocal cord paralysis and hypoparathyroidism, were much higher in the IS group than in the AS group. A portion of patients underwent conversion surgery (CS) due to disease progression and other various reasons, and the postoperative recurrence rate did not differ between the CS and the IS groups. Taken together, AS is appropriate as the initial management for PTMC patients.