Long-term results in the treatment of carcinoma of the thyroid

Abstract

This report consists of a review of the surgical procedures and long-term follow-up results in 122 patients with documented carcinoma of the thyroid who were seen at Duke Hospital from 1930 to 1962. Thyroid lobectomy or subtotal thyroidectomy was performed in the majority of patients with papillary adenocarcinoma with only 6 per cent of these patients dying with thyroid cancer. Although six patients had proved tumor recurrences in the residual thyroid tissue, all are now living after more extensive thyroid resection and now have no further evidence of tumor spread. In addition, several interesting cases of prolonged survival of more than ten years with widespread metastases are noted. Total thyroidectomy was reserved primarily for more malignant follicular or undifferentiated tumors which rarely remain confined to the neck, being disseminated by the hematogenous route in many instances. The variation in biologic response of the more invasive undifferentiated tumors was also evident in three long-term survivors after thyroid resection. Regional lymph node dissections were limited to patients with gross evidence of nodal involvement with tumor. Ten patients with follicular or papillary tumors who did not have palpable nodes initially later required neck dissection for spread of tumor. Only one death occurred in a patient in whom carcinoma of the breast later developed and who was found to have widespread tumor originating in either the thyroid or the breast. Thirty-five remaining patients never underwent node dissection with no apparent adverse effect on the long-term survival. These observations emphasize the relatively benign clinical course associated with papillary carcinoma and suggest a conservative surgical approach limited to lobectomy with subtotal resection of the contralateral lobe. Total thyroidectomy should be reserved for patients with follicular and undifferentiated tumors. Regional lymph node dissection offers no benefit in the absence of palpable nodes. Finally, the variation in host response of these tumors should promote caution when one attempts to offer prognosis, even in the presence of wide-spread tumor.