TOTAL THYROIDECTOMY DOES NOT ENHANCE DISEASE-CONTROL OR SURVIVAL EVENIN HIGH-RISK PATIENTS WITH DIFFERENTIATED THYROID-CANCER

Summ. Background Data The extent of primary thyroidectomy for differen tiated thyroid cancer is controversial. There are strong proponents fo r total thyroidectomy based on its presumed and theoretical disease co ntrol benefits. In contrast, there are equally strong advocates of les s aggressive thyroidectomy with its lower hazard of parathyroid and re current nerve injury. The authors have addressed whether total thyroid ectomy has a survival benefit justifying its use in patients with high -risk primary cancer. The major risk factors include age and the follo wing the pathologic determinants follicular histology, vascular invasi on, and extra-capsular extension. Materials and Methods The clinical p athologic, therapeutic, prognostic, and outcome data were reviewed in 347 patients with well-differentiated thyroid cancer. Seventy-five per cent were women, 216 patients were in the younger age group (low-risk) (21-50 years), 103 were in the intermediate-risk group (51-70 years), and 28 were in the high-risk group (>70 years). Included in the highr isk pathologic category were 158 patients who had follicular histology (55), extracapsular extension (107), or vascular invasion (119). Tota l thyroidectomy was performed in 56 patients, near or subtotal thyroid ectomy in 47 patients and lobectomy in 55 patients. The 10-year diseas e specific survival in the overall patient group was 82% in patients w ith total thyroidectomy, 78% in patients with subtotal thyroidectomy, and 89% in patients with lobectomy (p = 0.30). There was no significan t survival difference according to extent oi thyroidectomy in the inte rmediate or high-risk groups either by age or in patients who had high -risk pathologic feature. Conclusions Total thyroidectomy in high-risk patients with differentiated thyroid cancer (containing follicular hi stology, vascular invasion. or extracapsular extension) showed no bene fit over partial thyroidectomy, This suggests that the general use of total thyroidectomy is not indicated, except in highly selected patien ts.