[Surgical treatment of differentiated carcinoma of the thyroid. Follow-up of 99 cases].
The surgical treatment of differentiated thyroid carcinoma continues to be a matter of considerable debate in terms of defining the appropriate extent of thyroid or lymph node resection to ensure optimal patient survival. Whereas, at organ level, the majority of surgeons are in favor of total thyroidectomy, both the extent and timing of lymphadenectomy remain controversial issues. In the light of this, the Authors have conducted a retrospective study in 99 consecutive patients with differentiated thyroid carcinoma. As regards the distribution of the cancers in terms of TNM staging, 60 were stage I, 27 stage II, 11 stage III and 1 stage 4. Almost all the patients underwent total thyroidectomy. Lymphadenectomy was performed at the same time as thyroidectomy in papillary cancers when the nodes were clinically palpable and at a later date in those cases where the nodes subsequently became palpable at follow-up. The in-hospital mortality was 3% and was unrelated to the operation. The median follow-up was 95.8 months (7.98 years). Sixty-nine patients are still alive (71.8%), 66 of them disease-free (68.7%) and 3 with lymph node metastases (3.1%). Our results and those of other investigators suggest that total thyroidectomy should be the first therapeutic choice in differentiated cancers of the thyroid, but allow us to draw no firm conclusions regarding the controversial issue as to which type of lymphadenectomy can best ensure patient survival. To solve this problem we believe that multicenter randomized trials will be necessary. However, progress in molecular biology and tumor genetics is likely to enable us to identify new prognostic factors which may prove useful when deciding on the most appropriate therapeutic option.
Pozzetto
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B
Istituto di Clinica Chirurgica Generale e Terapia Chirurgica Università degli Studi di Trieste.
Roseano
M
M
Dellach
C
C
Leggeri
A
A
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D018263:Adenocarcinoma, Follicular / Q000401:mortality / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018276:Carcinoma, Medullary / Q000401:mortality / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000401:mortality / Q000601:surgery*; D018265:Carcinoma, Papillary, Follicular / Q000401:mortality / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D011183:Postoperative Complications; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000401:mortality / Q000601:surgery*; D013965:Thyroidectomy; D013997:Time Factors