Thyroid cancer: 30 year review of 201 cases

Abstract

Our 20 year survival rate of 75 per cent for patients with papillary cancer is higher than the rates reported in most series [ 2,8], especially since none of the high-risk patients were excluded from our calculations. Similarly, the incidence of complications is considerably lower. Part of this improvement reflects the operative technique used. In addition, the increased proficiency of a single surgeon in a private setting who performs over 200 thyroidectomies for cancer and over 2,700 thyroidectomies in 30 years undoubtedly lessens the incidence of complications and improves the prognosis. The improvement in survival statistics for papillary cancer over the past 30 years is dramatic. With the supplementation of exogenous iodides to the dietary regimen, the incidence of large goiters that occasionally masked an underlying carcinoma has declined, and the delays in surgical referral and treatment are less frequent. In addition, earlier patient presentation, changing pathologic criteria, and better diagnostic techniques have improved patient survival for papillary carcinoma. A review of the surgical treatment of thyroid cancer is a review of surgical trends in disease. Surgery for thyroid cancer has been tailored to fit the changes in clinical presentation. In earlier days, more patients presented with large tumors, often with positive nodes and local invasion. Such patients underwent total thyroidectomy with bilateral radical neck dissection. With the transition to earlier clinical presentations and less extensive disease, surgical treatment has also become less extensive, with improvement in the survival rate and a decrease in the rate of complications.