SELECTIVE TREATMENT OF DIFFERENTIATED THYROID-CARCINOMA

Over a period of 20 years 84 papillary and 82 follicular carcinomas op erated on by one surgeon and examined by one pathologist were document ed prospectively, treated selectively, and followed for 1 to 20 years (median 7 years). Tumors with a low risk of recurrence or incurable di sease-i.e., papillary carcinoma pT1-3 N0 M0 (n = 56) and minimally inv asive follicular carcinoma (n = 37)-were treated by a limited-radicali ty hemithyroidectomy or total thyroidectomy without radioiodine in 79 of the 93 cases (85%). No unfavorable course was observed, and only on e curable recurrence (1.3%) developed contralaterally after hemithyroi dectomy for papillary cancer. Of the remaining 73 patients, including 100% of those with nodal involvement, 65 (89%) underwent total thyroid ectomy with radioiodine. Total thyroidectomy was achieved in 34% of th e cases by completion thyroidectomy, based on definitive histologic ex amination. No instance of a serious, potentially incurable recurrence and no tumor-related death was observed in patients with a papillary T NM stage I + II or with a minimally invasive follicular carcinoma. Fiv e of the patients (Gk) with papillary carcinoma, all with TNM stage II I or IV, and seven of the patients (8.5%) with follicular carcinoma, a ll grossly invasive and pT3 or pT4, had tumor-related deaths following total thyroidectomy in all and with remnant ablation in 10 cases. A p otentially curable node recurrence occurred in two patients 1 and 10 y ears, respectively, after primary treatment; Permanent hypoparathyroid ism (n = 4) (2.4%) and permanent recurrent laryngeal nerve palsy (n = 2) (1.2%) were observed only in patients with a grossly invasive folli cular carcinoma and concomitant benign recurrent goiter. We conclude t hat (1) hemithyroidectomy or total thyroidectomy without radioiodine i s adequate for papillary carcinoma pT1-3 N0 and minimally invasive fol licular carcinoma; (2) there were no nodal recurrences in tumors recog nized as node-negative; and (3) extracapsular excision of one or both lobes ran be carried out technically with tow morbidity. The study con firms the prognostic value of age-related TNM classification for papil lary carcinoma; classification of follicular thyroid carcinoma as mini mally invasive or grossly invasive proved to be useful.