[Retrospective study of 266 patients with differentiated thyroid cancer. Current surgical options]

Total thyroidectomy (TT) is considered to be more efficient and more widely used than conservative thyroidectomy (CT) in patients with differenziated thyroid cancer (DTC). Anyway recently CT has been reevaluated in the treatment of DTC sharing favorable prognostic factors, due to the introduction of mini-invasive neck surgery. Such technique are indeed more feasibly applicable to CT than to TT. In this retrospective study we report the results of these surgical approaches in a series of patients with DTC.

Since 1985 up to 2002, 329 patients with thyroid neoplasm (134 female, aged between 13 and 88) underwent to surgery in our Department. Sixty-three were diagnosed as non-DTC and therefore excluded from this study. The remaining 266 were divided into two groups according with the surgical treatment: the I group (82 patients) underwent to CT, the II group (184 patients) had TT. Several clinical/pathological parameters were analyzed in comparison in the two groups.

60.3% of TT and 80.4% of CT had a single node presentation (p < 0.001 chi-square), whereas multinodular presentation was found in 28.4% of TT and in only case of CT. The mean size of the node was 2.9 +/- 0.8 cm in TT and 1.3 +/- 0.5 in CT (p = < 0.001 t-test). The follicular hystotype was more frequent in TT (37%) than in CT (13%) (p = 0.006 chi-square), whereas papillary form and capsule invading tumors were equally distributed. There was a lymphatic involvement in 20% of TT. Peri-operative mortality is absent; transitory and definitive recurrent nerve lesions were more frequent in TT then n CT (2.1% vs 1.2%); 2.2% of TT and no case in CT had hypoparatiroidism. Ten TT patients (5.5%) and 3 CT cancer (3.6%) died for thyroid cancer. Out of the latter 2 had a capsule-infiltrating form. Finally 4 CT patients had controlateral recurrence (4.8%): two of them had a follicular form and two a papillar one, with mean size of 2.5 cm.

Although TT is currently considered as the approach of choice for the oncologic accuracy and the correct follow-up, CT is having increasing application for low-risk patients in open and video-assisted surgery especially in the case of an incidental post-operative diagnosis of malignancy. The increasing use of modern technology such as high resolution ultrasounds and nuclear imaging (PET) will allow a more accurate follow-up of CT patients, with an early recognition of either lymphatic or local recurrences.