Impact of initial surgical treatment on survival of patients with differentiated thyroid cancer: Experience of an endocrine surgery center in an iodine-deficient region

This retrospective clinical study was designed to analyze the impact of the initial surgical procedure on the survival of 1000 patients with different iated thyroid cancer of follicular cell origin who had a thyroid operation and were followed for the 30 years between 1968 and 1998 (median 14 years) in an iodine-deficient region where goiter is endemic There were 753 women and 247 men with a mean age of 42.8 +/- 6.7 years (range 17-86 gears). Pati ents were divided into three groups. All patients had undergone thyroxine t reatment and thyroid-stimulating hormone (TSH) suppression, and most had ha d iodine-131 treatment postoperatively. Group A consisted of 336 patients w ith differentiated thyroid cancer (DTC) who were treated with bilateral sub total thyroidectomy in our institution or elsewhere. Group B consisted of 1 58 patients with DTC who were treated initially with unilateral total lobec tomy and contralateral subtotal lobectomy in our institution or elsewhere a nd underwent reoperation in our department. Group C consisted of 506 patien ts with DTC who were treated initially with total or near-total thyroidecto my in our department. Kaplan-Meyer survival analysis was used. Recurrence w as seen in 23% and death in 8% of the patients. The 20-year survival rates were 76%, 85%, and 92% for groups A, B, and C, respectively. The survival d ifference among the patients of group A and groups B and C was found to be statistically different (p < 0.001). Long-term survival of patients with di fferentiated thyroid cancer living in endemic areas for goiter fan be influ enced by the initial surgical treatment. Patients treated initially with to tal or near-total thyroidectomy appear to have a better prognosis.