POST OPERATIVE LOCO-REGIONAL PERSISTENCE AND RECURRENCES OF DIFFERENTIATED THYROID CARCINOMAS

Aim of the study: Evaluation of frequency and outcome of loco-regional persistance and recurrences of differentiated thyroid carcinomas afte r surgery. Material and methods: from 1964 to December 1990, we operat ed and followed up more than 5 years (from 5 to 31 years); 589 thyroid cancers (309 papillary, 262 follicullar et 18 Hurthle cells); 145 pat ients were lost to follow-up (24%), 33% of them were microcarcinomas. Surgery consisted ultimately in 411 total thyroidectomies, 51 sub-tota l thyroidectomies, 113 lobectomies with isthmusectomies, 9 isthmusecto mies or tumorectomies and 4 tracheotomies. Neck dissection was not rou tinely performed but rather selectively (n = 137). All Patients were p ut under suppressive hormone therapy. After total thyroidectomy, ablat ive 131 iodine was almost routinely done. All patients have been contr olled by clinical examination, radio-iodine scanning and, since 1983, by sequential thyroglobulin assays. We have analysed the course of pat ients according to L.J. Degroot's staging (Stage I : Patient with intr athyroidal disease. Stage II : Patient with cervical node involvement. Stage III : Patient with extra-thyroidal neck invasive disease. Stage IV : Distant metastasis). Results : Stage I, n = 383. Stage II, n = 9 6. Total = 479. Local recurrences in the bed of total thyroidectomy we re exceptional : n = 2/323 (0,6%). Recurrences in the thyroid remnant after non total thyroidectomy were rare : n = 3/156 (2%). Cervical nod al recurences were also rare : n = 7/479 (1,5%). Stage III (n = 73) : 34/306 papillary, 9/78, well differentiated follicular, 25/175 poorly differentiated follicular. 2/9 follicular of other type and 3/18 Hurtl e cell.