[Evaluation of results after repeated radical surgery for differentiated thyroid cancer]

Total thyroidectomy is the treatment of choice in thyroid cancer. Unfortunately, the diagnosis is not always established before the first operation and the secondary radical surgery is necessary. The aim of this study was to analyze the effectiveness of secondary surgery in differentiated thyroid carcinoma. The randomized group of 768 patients with differentiated thyroid carcinoma, treated in Oncology Center Institute in Gilwice between 1986 and 1997 was analyzed. Among them 474 persons (56%) - 398 females and 76 males (median age 44 years) were operated more than once in different clinics in Poland. They were compared with 136 persons operated by less radical approach. Negative histobiological risk factors were noted in 4% to 33% of cases. Cervical lymph node metastases were observed in 18% of patients. Distant metastases occurred in 3% of cases. 373 persons were treated with 131(I). All patients administered hormonal therapy to suppress TSH. After secondary operation the rate of cancer foci was 28% (when radicalization was performed durning one year after primary surgery) and 56% when it was done later. This difference was statistically significant (p=0,0002). Locoregional recurrence was observed in 5% of patients. In the entire examined group the actual 5-year-survival was 98% and 10-year-survival was 92%. Complete remission was observed in 80% of patients. The incidence of multifocality in 1/3 of cases and the presence of neoplasm in the re-operated thyroid gland in 1/4 of cases have substantiated the decision for secondary surgery. The delay in radicalization surgery of more than 12 months has doubled the risk of multifocality in thyroid gland remnants. Our results have confirmed the necessity of the secondary surgery after nonradical primary thyroid resection in differentiated thyroid carcinoma.