Endocrinologie et syndrome métabolique
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Searching of Rational Volume Surgery in Cases of Locally-Invasive Differentiation Thyroid Cancer

Romanchishen AF, Bagaturia GO and Tovbina MH

Introduction: Surgical intervention is the preferred method for eradicating invasive thyroid carcinoma (TC), but the extent of resection is still controversial.
Materials and Methods: A total of 2593 patients were operated on for differentiate TC between 1973 and 2007. Wide extrathyroid TC spread (T4) was fined in 464 (21.9%) cases of 2115 included in that research. We performed 256 combined thyroid and adjacent organ resections, 246 extended neck and mediastinum lymphadenectomy, 146 palliative operations. Transsternal approach have used during 31 operations. Totally were carried out 581 such operation at 441 patients. There were 19.2% males, 80.8% females (1:4.2). Average age made 57.7. Papillary TC was found in 62.9%, follicular - in 24.8% and medullar - in 12.3%. TC extension on muscles of neck and larynx (73.8%), RLN (37.9%), trachea (35.2%), pharynx and esophagus (23.8%), main neck or meditational vessels (21.9%) were
found.
Results: Seven patients died after 435 operations. No lethal outcomes happened of 97 patients operated on into two stages. Unexpected RLN palsy, temporary HPT observed at 6.2%. Follow up results (median 9.6+0.9) were investigated in 84.9%. The 5-year survival rate made 81.9% and 10-year – 71.1% after combined and 86.7% and 70.6% - after extended operations. The local failure rate after organs paring “shaving” and “wedge” aero digestive organ resections were not significantly worse than after of those circular resections (9.8% and 3.7%). But quality of life, 5 and 10 years survival rates after organ-sparing were much better (80.5% and 35.7% compared to 76.0% and 7.1%). 5-year follow-up results after palliative operations made 40.7% in papillary and follicular TC cases and 17.1%
- in medullary carcinoma. 29.1% of differentiated TC patients were alive after palliative operations, adjuvant therapies during 10 and more years.
Conclusion: “Shave” excision, “wedge” resection procedures in cases of TC aerodigestive organ invasions have produced better results than “sleeve” resection for recovery and improving of patient’s quality life.