[Recent advances in surgical treatment of thyroid carcinoma]

Patients with thyroid carcinoma must be treated considering on the biological behaviour of the tumor. It has been noted that papillary and follicular carcinomas grow very slowly while anaplastic carcinoma very rapidly. Postoperative recurrence rate of differentiated carcinomas was calculated on 390 patients who were followed for over 10 years after various operative procedures. The recurrence rate was closely related to the tumor size rather than operative procedure and was about 10% in carcinoma below 2 cm in diameter for which enucleation or partial thyroidectomy was carried out. Recurrence rate in the remnant thyroid was higher in the group of enucleation and partial thyroidectomy than in the groups of lobectomy and subtotal thyroidectomy. Recurrence in lymph node was found more frequently in the groups of more extended dissection. Operative procedures performed in 97 patients who had recurrence were total removal of the remnant thyroid, extended dissection of mediastinal lymph nodes and combined removal with the trachea and vessels. From these experiences, a criterion of initial operation for thyroid cancer was accomplished. Prophylactic dissection was attempted in recent 193 patients with differentiated carcinoma, and revealed a high frequency of lymph node metastasis, that was 70%. Radiotherapy with 131I was carried out in 21 patients, and regression of metastatic foci was observed in all patients with follicular carcinoma and a half with papillary carcinoma. For anaplastic carcinoma, multidisciplinary treatment was attempted, but no satisfactory effects were obtained.