Surgical treatment of thyroid cancer: the Singapore General Hospital experience

Patients with differentiated thyroid cancers generally have a good prognosis. This should be considered when deciding the extent of surgical resection. Radical surgery, however, may be appropriate in the control of locally advanced disease. An audit of 149 cases of thyroid cancer treated in the Department of General Surgery, Singapore General Hospital between October 1988 and June 1994 is presented. Particular attention is drawn to eight patients who underwent radical surgery. There were 111 (74.5%) women and 38 (25.5%) men. The median age was 45 years (range 12 to 83 years) and 80.5% of the cancers were papillary carcinomas, 14.8% follicular, 2.7% medullary and 2.0% anaplastic. Total or near-total thyroidectomy was the most common procedure for primary disease in about 75% of patients. Eight patients (5.4%) underwent radical surgery-four laryngectomy, one pharyngectomy and three median sternotomy-for tumour clearance. Morbidity included: wound complications in 2%; hypocalcaemia, transient in 16.8% and permanent in 3.4%; and hoarseness of voice in 8.1% with 4.7% having proved recurrent laryngeal nerve palsy. All three patients with anaplastic thyroid cancer died within 3 months. Of the eight who underwent radical surgery, three (37.5%) are alive and disease-free at median follow-up of 20 months. In a correctly selected group of patients with locally invasive differentiated thyroid cancer, aggressive surgery is appropriate, with acceptable morbidity and mortality.