Aggressive surgical therapy for locally invasive differentiated thyroid carcinoma : an experience of nineteen (19)‎ cases

الملخص EN

Background : It is well recognized that the optimum resection of locally advanced differentiated thyroid cancer invading adjacent vital neck structures is still controversial.

This report analyzes patients and tumor characteristics, anatomic structures invaded, surgical procedures, postoperative complications, adequacy of tumor resection, and follow-up of all patients.

Purpose : To re-evaluate the role of extended surgical therapy regarding its impact on local disease control and disease-free survival in patients with locally invasive differentiated thyroid carcinoma.

Patients and Methods : This is a prospective study, carried in the National Cancer Institute, Cairo University, between January 2002 and January 2008 on 19 patients with primary differentiated thyroid carcinoma extending extra thyroid and invading surrounding neck structures .All patients were followed for a period of 4 to 60 months and received a form of adjuvant therapy.

Results : The median age at diagnosis was 54 years.

There was slight female predominance (1 : 1.1), 84.2% of the tumors were papillary, 63.2% were grade 2 and 31.6% were clinically cervical node negative.

The most common structure involved was the skin of the neck (36.8%), which was reconstructed by deltopectoral fascio-cutanuous flap in the majority of these cases.

There was an incidence of 15% wound complications, 10% permanent and 37% transient hypoglycemia, 22% hoarseness of voice and 16%incidence of Honer’s Syndrome.

The safety margin was positive in 10% of the patients.

Disease-free survival was 85.6% at the end of the first year and 66.5% at the end of the second.

Conclusion : Microscopic positive safety margins did not compromise disease-free survival in the nineteen patients when surgery was followed by adjuvant therapy.

This treatment protocol is suitable in tumors with surface invasion of the upper aeorodigestive tract and those invading the recurrent laryngeal nerve.