Principals of limited or radical surgery for differentiated thyroid cancer

Since the late sixties standard total thyroidectomy with or without selective radical neck dissection depending on the extent of the disease has become the routine surgical procedure for differentiated thyroid carcinoma (DTC;-papillary, follicular). This strategy has contributed remarkably to the increase of cure rates for various reasons. Only recently, in the last decade, has limited radicality with only unilateral lobectomy (= hemithyroidectomy) with or without partial contralateral resection been advocated as being sufficient for selected early tumor stages. We have analyzed a series of 252 patients, 174 (69%) being papillary and 78 (31%) follicular. Primary operation was done in 117 patients (46%) while 135 patients (54%) underwent reoperative surgery at this institution for either completion of radicality or because of loco-regional recurrence. From our evaluation we draw the conclusion that limited radicality (unilateral operation or subtotal) is justified only in pT-1-tumors in younger age (< 45 yrs) in order to avoid recurrence and unnecessary reoperation. On the other hand generous indication for reoperation is justified with the overall chance of almost 60% cure rate. All adjuvant treatment, mainly radioiodine should be applied thereafter.