{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T02:16:11Z","timestamp":1767838571587,"version":"3.49.0"},"reference-count":32,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2009,12,10]],"date-time":"2009-12-10T00:00:00Z","timestamp":1260403200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2010,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Intense disease surveillance and frequent lymph node metastases (LNMs) in papillary thyroid cancer (PTC) have resulted in increased locoregional recurrences. We examined the safety and efficacy of an optimized surgical approach including preoperative ultrasonograpy (US), bilateral thyroidectomy, routine compartment VI dissection, and lateral neck dissection for LNM.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>During 1999\u20132006, a total of 420 patients underwent optimized primary surgery; 291(69%) females, median age 46 years; follow\u2010up 98%, median 4.4 years. Patients were reviewed for tumor characteristics, pattern of LNM, staging, and outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Total or near\u2010total thyroidectomy was performed in 212 (51%) and 208 (49%) patients, respectively. Tumors were multicentric, 40% (average 1.7\u00a0cm); were bilateral, 30%; and showed extrathyroidal extension, 17%. Overall, 223 (53%) patients had LNMs: 213 (51%) were central and 85 (20%) were lateral jugular. pTNM staging: I, 258 (61%); II, 35 (8%); III, 88 (21%); IV, 39 (9%). AGES (age, grade, extension, and size\u2014thyroid tumor; and MACIS (metastasis, age, completeness of resection, invasion, and size) prognostic scores were low risk in 362 (86%) and 352 (84%), respectively. Relapse developed in 57 (14%) patients: LNM in 44, soft tissue local recurrence (LR) in 5, distant metastases (DM) in 8. Hypoparathyroidism occurred in 5 (1.2%) patients and 1 had unintentional laryngeal nerve damage. Relapse with LNM occurred in previously operated fields in 19 (5%) patients, 11(3%) from disease virulence (LR or DM), preoperative false\u2010negative (FN) US in 12 (3%), and combination of FN\u2010US and recurrence in the operated field in 5 (1%) patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Recurrence was limited to 5% of patients when the extent of disease was accurately defined and potentially curable. This optimized surgical strategy is relatively safe.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-009-0307-9","type":"journal-article","created":{"date-parts":[[2009,12,9]],"date-time":"2009-12-09T12:51:04Z","timestamp":1260363064000},"page":"1239-1246","source":"Crossref","is-referenced-by-count":59,"title":["Risks and Adequacy of an Optimized Surgical Approach to the Primary Surgical Management of Papillary Thyroid Carcinoma Treated During 1999\u20132006"],"prefix":"10.1002","volume":"34","author":[{"given":"Clive S.","family":"Grant","sequence":"first","affiliation":[{"name":"Department of Gastrointestinal and General Surgery Mayo Clinic 200 First Street SW 55905 Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John M.","family":"Stulak","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal and General Surgery Mayo Clinic 200 First Street SW 55905 Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geoffrey B.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal and General Surgery Mayo Clinic 200 First Street SW 55905 Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melanie L.","family":"Richards","sequence":"additional","affiliation":[{"name":"Department of Gastrointestinal and General Surgery Mayo Clinic 200 First Street SW 55905 Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carl C.","family":"Reading","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Radiology Mayo Clinic 200 First Street SW 55905 Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian D.","family":"Hay","sequence":"additional","affiliation":[{"name":"Division of Endocrinology and Internal Medicine Mayo Clinic 200 First Street SW 55905 Rochester MN USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2009,12,10]]},"reference":[{"key":"e_1_2_6_2_2","first-page":"1088","article-title":"Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system","volume":"102","author":"Hay ID","year":"1987","journal-title":"Surgery"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010002\u20106612\u20101"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0039-6060(98)70034-0"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2006.16.1"},{"key":"e_1_2_6_6_2","first-page":"203","article-title":"AACE\/AAES medical\/surgical guidelines for clinical practice: management of thyroid carcinoma\u07ddAmerican Association of Clinical Endocrinologists, American College of Endocrinology","volume":"7","author":"Thyroid Carcinoma Task Force","year":"2001","journal-title":"Endocr Pract"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0b013e31814697d9"},{"key":"e_1_2_6_8_2","unstructured":"Anonymous(2007)Thyroid carcinoma. 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