Isthmusectomy for well-differentiated thyroid carcinoma located to the isthmus: A report of two cases and review of the literature

Papillary thyroid cancer is the most common endocrine malignancy, and due to its favorable prognosis, the extent of surgery has been a matter of debate. About 10% of these tumors are located in the thyroid isthmus, with no specific management in current guidelines. In the last decades, isthmusectomy has been proposed as a therapeutic option for isthmic papillary thyroid carcinoma, although there is no consensus on its management. We present two cases of patients from our institution with solitary isthmic papillary thyroid carcinoma without clinical macroscopic extrathyroidal extension or clinical-radiological lymph node involvement who were treated with isthmusectomy without prophylactic lymph node dissection. Neither of them had any postoperative complications. Both had an intermediate risk of recurrence due to aggressive variants. None of them had signs of recurrence during follow-up. We intend to show that isthmusectomy seems to be an effective and safe surgical alternative in selected patients through these cases.El cáncer papilar de tiroides es la neoplasia endocrina más frecuente, y debido a su pronóstico favorable, la extensión de la cirugía ha sido materia de debate. Aproximadamente el 10% de ellos están localizados en el istmo tiroideo, sin un manejo específico según las guías actuales. En las últimas décadas se ha propuesto la istmectomía como alternativa de manejo en el cáncer papilar de tiroides ubicado en el istmo. Presentamos los casos de dos pacientes con cáncer papilar de tiroides ístmico solitario, sin extensión extratiroídea macroscópica clínica ni compromiso ganglionar clínico ni radiológico, que fueron tratados con istmectomía sin disección ganglionar profiláctica. Ninguno tuvo complicaciones postoperatorias. Ambos fueron de riesgo de recurrencia intermedio debido a variantes histológicas agresivas. Ninguno tuvo recurrencia durante el seguimiento. Nuestro objetivo es mostrar que la istmectomía parece ser una alternativa quirúrgica efectiva y segura en pacientes adecuadamente seleccionados.