Le cancer différencié de la thyroïde chez l’enfant et l’adolescent

Abstract

Aim of the study: Evaluation of resection « à la demande » for differentiated thyroid carcinoma in young patients. Patients and methods: From 1963 to 1996, 70 differentiated thyroid carcinomas were observed in young patients (mean age: 16 years, range: 9–19 years). Three had pulmonary metastases. Resections were 39 extra-capsular lobo-isthmectomies (56%), 11 total lobo-isthmectomies with contra lateral subtotal lobectomies (16%), and 20 total thyroïdectomies « de nécessité » (28%). Lymph node resection was unilateral in 41 cases (58%), bilateral in 23 (33%), and more extended in 5 (7%). In tracheal ( n=8), esophageal ( n=4) or bilateral inferior laryngeal nerve involvement ( n=6), the visceral extension was preserved and surgery completed with postoperative external radiotherapy. In patients with pulmonary métastases surgery was completed with I 131. Two patients were lost of follow-up. The others were evaluated from 5 years to 28 years later. Results: There were no postoperative deaths, no laryngeal palsy except those existing before surgery. In 6 patients, resection was complicated by permanent hypoparathyroidism. In the follow-up, the death of two patients was not correlated with the thyroid carcinoma. Five patients who had a recurrence were reoperated and were alive without any sign of recurrence. All the patients were alive. Conclusion: These results suggest that in children and adolescent patients, without previous irradiation, a surgical procedure “à la demande” is justified. Preservation of tracheal, esophageal or laryngeal involvement, followed by postoperative radiotherapy was associated with good results.