SURGICAL TREATMENT OF DIFFERENTIATED THYROID CARCINOMA

Abstract

Being the excellent prognosis, the extension of the thyroi dectomy in the surgical management of differentiated thy roid carcinomas is still controversial: some authors recom mend total thyroidectomy for all patients, Others suggest a conservative approach, that guarantee the same good pro gnosis but is associated with fewer complications. Even the cervical lymph node dissection is discussed, both regarding to the indications and the extension.

The authors reported a retrospective review of their expe rience of the last 10 years on 75 patients operated for dif ferentiated thyroid cancer, 61 for papillary carcinoma and 14 for follicular carcinoma; 18 of them were men and 57 females, with a mean age of 48.2 years.

We performed a total of 85 operations: 60 total thyroidec tomy, 15 lobus-isthmusectomies and 10 completion thyroi dectomy. Lymphadenectomy was performed in 17 patients with clinically or intraoperative evidence of enlarged lymph nodes. There was no surgical mortality. Permanent hypo parathyroidism occurred in 5 patients (5.8%) and perma nent accidental laryngeal recurrent nerve injury, both mono lateral, occurred in 2 cases (2.35%). The mean follow up was 53 months (4.5 years): 71 patients are still alive (94.7%), 68 of them disease free (90.6%) and 3 with recurrent disease (4%). Our results suggest that total thy roidectomy still represent the choice procedure for the treat ment of differentiated carcinomas and that modified radi cal neck dissection is necessary in these patients with pre or intraoperative evidence of palpable lymph nodes. Some patients go well even undergoing more conservative surgery (lobectomy) but most problem is the impossibility to preo peratively identify these patients.