What Should We Prefer in the Surgical Management of Differentiated Thyroid Carcinomas?

Abstract

Aim: The study evaluates the results of surgical procedures performed in patients with differentiated thyroid carcinoma. There are many discussions regarding the optimal surgical treatment of differentiated thyroid carcinoma; their focal point is the type or extent of thyroidectomy. Material and Method: We performed a retrospective analysis on 85 patients diagnosed with differentiated thyroid carcinoma, treated in the period July 2007-April 2017. The average age the patients, consisting of 15 males and 70 females, was of 41 (17-85) years. The gross findings at operation and the prognostic factors such as patients' age, tumour size, local invasion, nodal involvement and the presence of distant metastasis were taken into account when deciding on the type of thyroidectomy, and cervical neck dissection. Results: The most prominent symptom was the existence of a cervical mass (85%); fineneedle aspiration biopsy (FNAB) was performed in 73 patients and revealed a diagnostic accuracy in 61 patients (72%). Histological examination confirmed papillary carcinoma in 76 patients, follicular carcinoma in 8 patients and medullary carcinoma in 1 patient. When the diagnosis was established, 19 patients had palpable neck lymph nodes, and 25 patients had a local invasion to surrounding structures. While total thyroidectomy was performed in 71 (83.5%) patients, 11 (12.4%) patients underwent lobectomy and subtotal thyroidectomy, and 3 (3.5%) patients underwent lobectomy and near-total lobectomy. Modified neck dissection was added to 13 patients who underwent total thyroidectomy. No operative mortality was observed, and the cancer-related mortality rate was 10.2%. Temporary and permanent hypoparathyroidism rates were 5% and 1.1%, respectively. Temporary and permanent recurrent nerve paralysis was observed to be of 3% and 0%, respectively. Conclusion: The selection of treatment for differentiated thyroid carcinoma should be made based on risk factors. All procedures such as lobectomy + subtotal lobectomy, near-total thyroidectomy, and total thyroidectomy are selected in safe conditions. In addition to total thyroidectomy, modified neck dissection should also be considered for patients with differentiated thyroid carcinoma with nodal involvement.