INCIDENCE OF REGIONAL RECURRENCE GUIDING RADICALITY IN DIFFERENTIATEDTHYROID-CARCINOMA

Total thyroidectomy has become the routine procedure for treatment of differentiated thyroid carcinoma. However, the necessity of unilateral or bilateral neck dissection is far less standardized. Our usual proc edure has been to perform a routine neck dissection in T4 tumors and i n all other tumor stages only in the presence of positive diagnostic o r intraoperative findings. The results concerning regional tumor recur rence in cervical lymph nodes subsequent to thyroidectomy are studied and discussed. Between April 1986 and December 1992 a group of 252 pat ients were operated on for differentiated thyroid carcinoma (DTC) (176 papillary, 76 follicular). Postoperative treatment included radioiodi ne therapy as a rule in all patients more than stage T1, and follow-up encompassed thyroglobulin measurements, cervical ultrasonography, and radioiodine scintigraphy. After a mean follow-up of 6.9 years, 77 (31 %) of the patients underwent reoperation because of regional tumor rec urrence [46 of 176 (26%) papillary, 31 of 76 (41%) follicular]. In pap illary thyroid cancer a significant difference could be demonstrated b etween patients with thyroidectomy only versus thyroidectomy plus neck dissection in all tumor stages (T2, 13 of 29 (45%) versus 1 of 34 (3% ); T3, 10 of 13 (77%) versus 4 of 11 (36%); T4, 6 of 8 (75%) versus 6 of 18 (33%) (p < 0.0001). Similar results could be achieved for follic ular thyroid cancer, showing statistical significance with regard to o perative procedure (p < 0.009). Our experience demonstrates a positive correlation of regional tumor recurrence with increasing tumor stage for both histologic tumor types. The high rate of regional recurrence justifies a more radical approach, including neck dissection at the in itial operation. The impact on survival, however, must be proved by fu rther evaluation.