[Retrospective analysis of the results of surgical treatment of 407 patients with differential thyroid gland cancer over a period of 23 years].

Over a period of 23 years (1980-2002) 407 cases of differential thyroid gland cancer were operated, monitored and analyzed at the Endocrine Surgery Clinic of Alexandrovska University Hospital. Of them 71.7% were monitored over a period of more than 10 years (up to 23 years), and 39.3% were monitored between 15 and 23 years. The youngest patient was 12 years old, and the oldest--78 years old. All patients were at a T(1-3) N(a-b) M0 stage. 308 (75.7%) patients had papillary carcinoma, and multi-centric localization was established in 3.9%, while capsular invasion and unilateral lymph-nodular metastases--in 6.2% of those patients. Follicular cancer was found in 24%, and vascular invasion--in 15.1%. 72.4% of the patients fall within the low-risk age groups (women under 50 years of age and men under 40). The treatment of 22.1% (90) of the patients comprised thyroidectomy with a follow-on 131J therapy. 77.9% (317) of the patients underwent radical thyroid gland resections of various size. Bilateral subtotal resections were applied most often--in 64.5% of all cases, and the rest of the patients underwent lobectomy with contra-lateral subtotal resection. The recurrence rate among the patients treated with radical resections is 6.1%, mainly within the high-risk age group. No correlation was established between the recurrence rate and the type of organ-saving surgery. In the group of patients treated with thyroidectomy and 131J, recurrences of the disease were established in 16.2%, again mainly within the high-risk age group. Remote metastases and mortality were established in 3% and 2.5% respectively. In conclusion, preference is given to organ-saving surgical treatment of differential thyroid gland cancer, and it is recommended that in the high-risk age groups the operations be of a broader scope.