Operative strategy for thyroid cancer. Is total thyroidectomy worth the price?

Abstract

The authors conducted a retrospective analysis with 5-to 30-year follow-up on 109 patients in order to determine the optimum management of nonmedullary thyroid cancer. Results of total thyroidectomy were compared to partial thyroidectomy, among patients well matched for prognostic indicators. No differences in cancer mortality or recurrence rates were evident. However, there were significantly more complications when total thyroidectomy was employed. In view of these results, partial thyroidectomy is recommended as the treatment of choice for nonmedullary thyroid cancer.Cancer 58:2320-2328, 1986.ONTROVERSY CONCERNING the treatment of non-C medullary thyroid cancer still exists, despite critical analysis of operative results for many years. Surgeons are divided into three camps: those advocating routine total thyroide~tomy,'-~ those advocating routine partial thyroidectomy (consisting of at least removal of one entirelobe and isthmus, to include a portion of the contralateral lobe when required for the resection of all gross tumor),6-' and those advocating total thyroidectomy selectively in patients displaying adverse prognostic fact o r~. '~-'~ The current study identifies the factors which influence prognosis and evaluates their implications on operative strategy. The advantages and complications of partial vcrsus total thyroidectomy are retrospectively evaluated. 1955 and 1979, 117 patients underwent thyroid surgery for nonmedullary primary thyroid carcinoma at Saint John Hospital in Detroit, Michigan. Follow-up with a minimum of 5 to 30 years (mean, 12.7 years) was possible in 109 patients by hospital and office records and by direct correspondence. Patients and Methods BetweenNomenclature devised by the American Thyroid Association was used for tumor clas~ification.~~ Papillary tumors were subdivided into pure papillary and mixed pap-

Long-Term Follow-Up After Complete Resection of Well-Differentiated Cancer Confined to the Thyroid Gland

“…42,43 In addition, proponents of limited resection base their strategy on publications reporting increased postsurgical complications with more extensive resection. 23 In the current analysis, we found an increased rate of transient postoperative hypocalcemia in patients treated with TR, but no difference in the rate of transient nerve paralysis. Previous studies on TR at our institution could not rectify limited resections based on nerve injury rates.…”

“…Data about DSS in these studies seem to justify limited thyroid resection, favoring lobectomy of the affected side over total thyroidectomy. 7,14,[23][24][25][26][27][28][29][30][31][32] In this retrospective study of a well-defined patient group with WDTC confined to the thyroid gland undergoing complete resection of the tumor, we sought to define long-term outcomes, to evaluate previously described prognostic factors for DSS in WDTC, and to determine the influence of the extent of thyroid resection, in particular.…”

A prospective clinical trial to assess the efficacy of radioiodine ablation as an alternative to completion thyroidectomy in patients with differentiated thyroid cancer undergoing sub-total thyroidectomy

“…Such patients may be left as such with thyroid suppression therapy, may be subjected to completion thyroidectomy or may undergo radioiodine ablation of the remaining thyroid tissue as a further management strategy [4]. Thyroid hormone suppression alone is considered a relatively weak form of adjuvant therapy [5]. The completion thyroidectomy following STT is not free from risks if operated by general surgeons not particularly trained for endocrine surgery, as both lobes of the thyroid have already been exposed and interfered with, and therefore, is associated with higher incidence of complications [6 Á8].…”

Papillary thyroid cancer

“…• The most important issue is one of results; that is, whether near-total or total thyroidectomy actually improves the condition of the patient with papillary thyroid cancer in the long term, and this is usually measured by recurrence and, most importantly, survival. This is where controversy exists because some studies show no survival advantage to total or near-total thyroidectomy [10••, [11][12][13], and other studies show not only decreased recurrence, but improved survival in patients receiving total thyroidectomy, usually with postoperative 131 I [7,14-18]. • There have been multiple retrospective studies showing that total or neartotal thyroidectomy can decrease recurrence, even in low-risk patients, and even improve survival in some studies.…”