Treatment of "locally advanced" well-differentiated thyroid carcinomas.
OBJECTIVE
To analyse thyroid carcinomas having an extrathyroid extension in order to identify the principal prognostic factors and outline an effective therapeutic strategy.


METHODS
We selected a sample of 160 patients suffering from locally advanced "well differentiated thyroid carcinoma (T4) who had undergone surgery at the Department of Surgery of University of Rome "La Sapienza". The sample was subdivided into three groups: T4, limited type I, and extensive type II, T4 microcarcinomas.


RESULTS
We obtained excellent results with the T4 microcarcinomas, above all in patients under the age of 45, with a 94.5% survival rate, compared with 88% in patients aged over 45. In the extensive type II T4 carcinoma we obtained a survival rate of 29.4% in patients aged over 45 years.


CONCLUSIONS
Age, combined with an aggressive histological variant (Sclerosing and tall-cell papillary carcinoma), is an important factor in prognosis. The radicality of surgical excision is considered an important prognostic factor, although the results reported in the literature are contradictory. Aggressive surgery can free from the disease a high percentage of patients over the age of 50 even with T4. We deem it fundamental to perform total thyroidectomy in all advanced cases of thyroid neoplasm and to extend neoplasm excision to the adjacent tissues, even involving justified surgical demolition.
Department of Surgical Sciences, 3rd training program in General Surgery, University of Rome La Sapienza, Italy. laurafalvo@mclink.it
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Falvo
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Catania
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Grilli
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Di Matteo
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De Antoni
D000328:Adult; D000367:Age Factors; D000368:Aged; D002277:Carcinoma / Q000097:blood / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D018276:Carcinoma, Medullary / Q000628:therapy; D002291:Carcinoma, Papillary / Q000628:therapy; D018265:Carcinoma, Papillary, Follicular / Q000628:therapy; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016019:Survival Analysis; D013963:Thyroid Hormones / Q000097:blood; D013964:Thyroid Neoplasms / Q000097:blood / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D013965:Thyroidectomy; D016896:Treatment Outcome
D007457:Iodine Radioisotopes; D013963:Thyroid Hormones