[Radical surgical treatment of differentiated thyroid cancer--necessity or over-enthusiasm?]

The extent of surgical treatment of well differentiated thyroid cancer has been controversial and widely discussed for years. Although the recommendations defining the strategy of thyroid surgery were approved in 1995, a lot of questions remained. The aim of this retrospective study was to analyse long-term results of surgical treatment of thyroid cancer according to the type of applied surgical procedure. The study group consisted of 206 patients surgically treated for well differentiated thyroid cancer with the minimal follow-up period of 5 years. The median age patients was 49.1 years. 159 patients (77.2%) have still remained in the follow-up programme, 23 died because of thyroid cancer (11.1%) and the remaining 24 have either refused to participate in the programme or died of other causes. Median follow-up period was 10.7 years. Total thyroidectomy was performed in 90 patients (43.7%) and less extensive procedures in 106 (51.4%). The remaining patients were qualified for palliative reduction of the tumour mass and they were not included in this study. The comparison of the patients with I and II stage of the disease according to the type of surgical procedure did not show differences in 10-year survival. In stage III the difference was very close to statistical significance. The same results were observed with regard to disease recurrence. Long-time survival in low risk patients was not related to the extent of surgical procedure. The risk of recurrence and death was higher in the patients with advanced disease in stage III who underwent less radical procedures like total resection of involved lobe with isthmus and subtotal resection of contralateral lobe.