Romanchishen, Anatoly1; Vabalayte, Kristina1
1 Department of Hospital surgery, Saint Petersburg State Pediatric Medical University; Saint Petersburg Center for Endocrine Surgery and Oncology, Saint Petersburg, Russia
Introduction. Insufficient surgical experience creates a real threat for a patient with an advanced thyroid cancer(??).
Materials and Methods. During 1974 – 2010, a total of 4040 patients underwent surgery for papillary (P), follicular (F), and medullary (M) TC. 145 patients were denied of surgery at other hospitals due to primary or recurrent TC. Among them, 21% males, 79% females. The mean age was 57.7±2.0. All 145 patients underwent combined surgeries (CS), with Sternotomy in 8.1% cases. 20.0% surgeries were palliative. Histological evaluation revealed P in 75.5%, F in 9.4% MTC in 15.1%.
Results. TC expansion was into the neck muscles (67.2%), recurrent nerve (37.9%), trachea (35.2%), larynx (13.7%), pharynx and esophagus (23.8%), large vessels (21.9%). Vocal impairment was found in 20.9%. Shaving resections of trachea, larynx, pharynx, and esophagus were performed when TC grew into the superficial layers of these organs; lateral resections – when the outgrowth reached submucosa. Further progression of the tumor growth up to or exceeding half of the organ circumference required circular resections. Unexpected specific complications were observed in 6.2%, lethality – in 1.6%. Long term results were followed up in 84.6%, during 9.7±1.9 years. Mean survival time after CS was 9.6±0.8. Organ-preserving surgery allowed five-year survival in 80.5%,10 year – in 71.2%, whereas after circular resection 35% and 7%, respectively. These 145 patients collectively survived for 783 years.
Conclusion. A qualified surgical aid in so-called inoperable TC allowed for a complete cure or for a significant life extension in the majority of patients.