COMPLETION THYROIDECTOMY IN 131 PATIENTS WITH DIFFERENTIATED THYROID-CARCINOMA

Objective: To evaluate the prognostic factors that influence survival and recurrence after ''completion'' thyroidectomy (removal of the tota l thyroid remnant after diagnosis of carcinoma has been made in a spec imen that was incompletely excised for a benign condition). Design: Op en study. Setting: Teaching hospital Germany. Subjects: 131 Patients ( 65 with papillary and 66 with follicular thyroid cancer) who underwent completion thyroidectomy after primary subtotal resection. Interventi ons: Indications for further operation were: tumour stage worse than p T(1) (n = 116), tumour stage pT(1) and the suspicion of persistence of the tumour (n = 13), and incompletely resected tumour (n = 2). Multiv ariate analysis by Cox's proportional hazards model. Main outcome meas ures: Recurrence, development of metastases, and length of survival. R esults: Patients who underwent their completion thyroidectomies within six months of the primary operation had significantly fewer recurrenc es, fewer lymph node metastases, fewer haematogenous metastases and su rvived significantly longer than those in whom the second operation wa s delayed for longer than six months. The age at the time of diagnosis and the stage of the tumour influenced survival, whereas sex and type of tumour did not. Conclusion: Completion thyroidectomy as soon as po ssible after incomplete resection of the tumour may improve prognosis in differentiated thyroid cancers the stage of which is worse than pT( 1) or in patients whose recurrent tumour is diagnosed at follow-up.