Surgical Treatment of Differentiated Thyroid Cancer

Han, Koon Taek

Abstract

BACKGROUND: There is considerable controversy about the surgical treatment of patients with differentiated thyroid cancer.
METHODS
A retrospective study of 45 patients who received surgical treatment during the 1-year period from January to December 1996 at Pusan National University Hospital was performed.
RESULTS
The age of the patients ranged from 14 to 72 years (mean age, 42.6 years). Eighteen patients (40.0%) were at the age of 45 years or older. There were 40 women and 5 men. Forty patients (88.9%) had papillary carcinomas and 5 patients (11.1%) had microinvasive follicular carcinomas. Papillary carcinomas had been documented in 36 patients (80.0%). Thirty-seven patients (82.2%) were treated by a total thyroidectomy, including all the patients at the age of 45 years or older. Regional lymph node dissections were performed in 36 patients (80.0%) along with a total thyroidectomy: central node dissection in 25 patients (55.6%) and central and lateral node dissection in 11 patients (24.4%). Frozen- section examinations were required in 25 patients (55.6%). The primary tumors were larger than 1.0 cm in 42 patients (93.3%). Extrathyroidal extensions of the tumors were noted in 14 patients (31.1%). Of the 35 patients with papillary cancer who were treated by a total thyroidectomy, 10 patients (28.6%) had bilateral diseases. Regional lymph-node metastases were proved in 20 patients (44.4%): central node metastasis in 11 patients (24.4%), lateral node metastasis in 7 patients (15.6%), and central and lateral node metastasis in 4 patients (8.9%). Two patients (4.4%) had lung metastases. The TNM stage groupings were as follows: Stage I, 60.0%; Stage II, 13.3%; Stage III, 24.4%; and Stage IV, 2.2%. The incidences of permanent hypoparathyroidism and accidental recurrent nerve injury following a total thyroidectomy were 2.7% and 0.0%, respectively. There were no operative deaths.
CONCLUSIONS
The authors conclude that a total thyroidectomy with routine central neck node dissection is the treatment of choice for patients with papillary thyroid cancerous tumors larger than 1.0 cm at the age of 45 years or over.