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Cancer of the thyroid
Cancer
of the Thyroid*
ORVILLE L. RICKEY, JR., M.D. AND ROBERT B. HOWARD, M.D., Oklahoma
From
St. Anthony Hospital, Oklahoma City, Oklahoma.
HE SURGICAL APPROACH to cancer of the
T thyroid
gland remains controversial. A variety of surgical procedures are recommended in the literature. There is a trend toward more radical excision of the thyroid gland and less radical treatment of the lymph glands of the neck. In this country the five and ten year survival rates for papillary carcinoma of the thyroid range from 74 to 94 per cent [1-P]. The thyroid gland is treated by unilateral lobectomy [I], total and subtotal lobectomy [Z], and total thyroidectomy [3]. Involved lymph glands of the neck are treated by radical neck dissection [P] or modified neck dissection to meet the requirement of adequate resection of the tumor in each case [I ]. The purpose of this paper is to present 110 cases of carcinoma of the thyroid gland not previously reported. These 110 cases occurred in a personal series of 1,595 thyroidectomies, a 6.9 per cent incidence of cancer. This series covers a twenty year period, and the surgical approach to the malignant lesions has been standardized for the past ten years. Current follow-up information is available on 108 patients (98.2 per cent). MATERIAL All patients were operated upon by one of us (R.B.H.). Table I presents the clinical evaluation of
the type of goiter. Carcinoma occurred primarily in patients with nodular nontoxic goiter (93 per cent). Table II presents the over-all survival statistics of
the 110 patients with carcinoma with regard to the pathologic classification; 65 per cent were papillary carcinomas. The over-all survival rate for patients with papillary carcinoma was 88.7 per cent. The over-all survival rate for those with follicular car* Presented
at the Eighteenth
cinoma was 88.9 per cent. Seventy-eight patients have been followed up five years or more and forty, ten years or more. Two patients lost to follow-up study had lived ten and thirteen years postoperatively and are included in the statistics as ten year survivors. A small number of lesions were classified as mixed papillary and follicular carcinomas and are considered herein according to the dominant cell type. The miscellaneous category includes seven lymphosarcomas, three Htirthle cell carcinomas, one schwannoma, and one scirrhous carcinoma. Table III lists the pathologic classification of the lesion of those seventy-eight patients followed up five years or more. Forty-four of these were papillary carcinomas, The ages of the seventy-eight patients at the time of diagnosis were as follows: ten to nineteen, six patients; twenty to twenty-nine, five; thirty to thirty-nine, sixteen; forty to forty-nine, twenty-two; fifty to fifty-nine, eleven; sixty to sixtynine, eleven; seventv to seventy-nine, six; eighty to eighty-nine, one patient. The surgical procedures performed on seventyeight patients followed up five years or more were as follows: total lobectomy and radical subtotal lobectomy, thirty-seven patients; total lobectomy and radical subtotal lobectomy with modified radical neck dissection, seven; total lobectomy and radical subtotal lobectomy with standard radical neck dissection, nine; unilateral total lobectomy, four; total thyroidectomy, seven; bilateral subtotal thyroidectomy, eleven; unilateral subtotal thyroidectomy, three. The variety of procedures exists because of the period of time covered (twenty years). During the past ten years surgical treatment of the thyroid gland has been total lobectomy on the primary side and radical subtotal resection of the opposite lobe. Lymph gland dissection is reserved for those patients with palpable suspicious lymph glands at surgery. Forty-four patients with papillary carcinoma in the group were followed up five years or more. The surgical procedures performed on these patients were as follows: total lobectomy and radical sub-
total lobectomy, twenty-one patients; total lobectomy and radical subtotal lobectomy with modified
Annual Meeting of the SouthwesternSurgicalCongress,Las Vegas, Nevada,
April 18-21, 1966.
Vol. 112. November
1966
City, Oklahoma
637
638
Rickey and Howard TABLE
INCIDENCE
OF
CARCINOMA
I
IN
TABLE
1,5%
THYROIDECTOMIES
HISTOLOGIC WITH
Total No. of No. with Patients Cancer
Clinical Diagnosis Diffuse toxic goiter Nodular toxic goiter Diffuse nontoxic goiter (thyroiditis, 78 cases) Nodular nontoxic goiter Total
301 235
2 4
87 972 1,595
2 102 110
radical neck dissection, four; total lobectomy and radical subtotal lobectomy with standard radical neck dissection for extensive jugular lymph gland metastases, four; unilateral total lobectomy, two; total thyroidectomy, four; bilateral subtotal thyroidectomy, five; unilateral subtotal thyroidectomy, four. Eight deaths occurred in the forty-four patients with papillary carcinoma. Three of these patients had palliative resections with either tracheal or esophageal invasion present at operation, and each died of the disease in less than five years. One patient died of carcinoma of the breast two years after thyroidectomy. Autopsy revealed no recurrence of the thyroid carcinoma. One patient survived five years only to die from pulmonary metastases. One patient survived twelve years and died from undifferentiated carcinoma of the thyroid. The preceding two patients who survived five and twelve years are included in the five and ten year survival statistics. Two other patients with curative resection died of the disease in two and four and a half years. The five year survival rate among those patients with resectable lesions is 92.5 per cent (thirty-eight of fortyone). The five year survival rate for the entire group of forty-four patients with papillary carcinoma is 86.4 per cent. Of the twenty-nine patients treated in the now standardized manner of total lobectomy plus radical subtotal lobectomy with or without neck dissection,
TABLE OVER-ALL
SURVIVAL
CANCER
Histologic Classification Papillary carcinoma Follicular carcinoma Undifferentiated carcinoma Miscellaneous Total
II
STATISTICS
OF
110
PATIENTS
WITH
OF THE THYROID
No. of Patients
No. of Deaths
Per cent of Survivors
71 18
8 2
88.7 88.9
9 12 110
7 5 22
22.3 58.3 80
CLASSIFICATION
CANCER
OF
THE THAN
III
OF SEVENTY-EIGHT
THYROID FIVE
FOLLOWED
PATIENTS UP
MORE
YEARS
Histologic Classification
No. of Patients
Per cent
Papillary carcinoma Follicular carcinoma Undifferentiated carcinoma Miscellaneous Total
44 19 8 7 78
56.5 24.3 10.2 9.0 100.0
only two patients have died, One died of cancer of the breast and the other of undifferentiated carcinoma recurring after twelve years. None has died of papillary carcinoma. Forty patients were treated before 1956. The five year survival rate among these patients is 75 per cent and the ten year survival rate, 72 per cent. The surgical procedures were not standardized during this period. Bilateral subtotal thyroidectomy or unilateral lobectomy was performed in seventeen patients, total thyroidectomy in six, and seventeen patients underwent total lobectomy with subtotal resection of the opposite side. Lymph node dissections were performed on seven occasions for involved glands. Thirty-eight patients were treated between 1956 and 1960. Thirty-five of these were treated in the now standard manner with total lobectomy and radical subtotal lobectomy of the opposite lobe. Six deaths occurred in this group from undifferentiated carcinoma in three, schwannoma in one, and lymphosarcoma in one. Only one patient with papillary or follicular carcinoma has died, death occurring two and a half years postoperatively from carcinoma of the breast, without evidence of recurrence of thyroid cancer. Two young female patients in the early group who presented with extensive disease bilaterally in the cervical lymph glands were treated with total thyroidectomy, standard radical neck dissection on the more extensively involved side, and modified neck dissection on the opposite side. One of these had pulmonary metastases when first examined. Both patients are alive and well twelve and fifteen years postoperatively. Pulmonary metastases are present on chest roentgenogram but unchanged in the past eight to ten years. All patients in this series were given suppressive doses of desiccated thyroid (2 to 3 gr. daily) postoperatively. Cobalt teletherapy has been used in those patients in whom the lesion was unresectable or extensive enough to cause doubt as to whether it had been completely removed. Radioactive iodine131 has been used in rare instances of functioning follicular lesions which were unresectable. AmericanJournal of Surgery
Cancer of Thyroid OPERATIVE
PROCEDURE
After exposure of the thyroid gland through the usual collar incision, each lobe is examined carefully along with the lateral part of the neck, paratracheal, and superior mediastinal node-bearing areas. If the Delphian lymph node is encountered, it is submitted for frozen section study. If node involvement is not detected, the lobe with the primary tumor (suspicious nodule) is treated by extracapsular total lobectomy with careful preservation of the recurrent laryngeal nerve and parathyroid glands whenever possible. Paratracheal lymph nodes are removed with this lobe whenever necessary. En bloc dissection is carried out across the isthmus into the opposite lobe or well beyond the nodule. This portion is submitted for frozen section study. If frozen section confirms the diagnosis of carcinoma, radical subtotal lobectomy is performed on the opposite side. After division of the superior thyroid vessels and middle thyroid vein, the lobe is rotated medially and the recurrent nerve identified and traced to the wing of the thyroid cartilage. A small portion of the thyroid capsule along the inferior thyroid vessels is left behind to assure parathyroid function. The lobe is removed leaving the fragment of capsule, thyroid parenchyma, and inferior parathyroid gland with its vascular pedicle. COMMENTS
The biologic activity of papillary carcinoma of the thyroid gland is very unlike that of other carcinomas. The slow sluggish rate of growth and late blood-borne metastases leave some room for conservatism in the surgical treatment of this lesion. Although local lymphatic spread may occur early and the cells grow luxuriantly in the lymph glands, often outgrowing the primary lesion, local invasion of surrounding tissues (esophagus and trachea) is a late occurrence. Surgical extirpation prior to local invasion gives excellent prospects for cure. The problems of multicentricity and intraglandular metastases have brought about a more radical approach to surgery of the thyroid gland itself. Some centers now recommend total thyroidectomy [P] although lobectomy alone is still considered adequate in other places [I ]. Extracapsular dissection of the entire thyroid gland is not to be taken Vol. 112, November 1966
639
lightly. The incidence of tetany after these procedures has been reported as high as 50 per cent. Permanent tetany is a disabling disease and is recently reported as occurring in 11.4 per cent of cases of total thyroidectomy [3]. Considering the relative benignancy of papillary carcinoma, one wonders if the cure cannot at times be worse than the disease, and if preservation of some parathyroid function should not be a paramount consideration. Recurrent nerve paralysis is also disabling and can, as a rule, be prevented. Knowledge of the anatomy of the area and careful identification and preservation of both nerves are essential. Attempts to minimize the complications and yet not compromise the chance for cure in this disease have led us to something less than bilateral extracapsular total thyroidectomy. The involved lobe is treated with extracapsular dissection but with careful identification and preservation of the recurrent laryngeal nerve and parathyroid glands whenever possible. The opposite lobe is treated with radical subtotal lobectomy. The purpose is to spare the parathyroid gland with its blood supply. To do this, the inferior thyroid vessels are preserved up to and including a rim of thyroid capsule. A small fragment of thyroid parenchyma remains within the capsule. Permanent tetany has not occurred in this series, and transient episodes of tetany have occurred in 3 per cent of the patients. Recurrent nerve injury has not occurred except when the nerve was involved with the tumor and then only unilaterally. Papillary and follicular carcinomas are treated surgically in the same manner. Undifferentiated carcinoma is resected as extensively as possible, but the survival rates are uniformly poor although two of the nine patients are living eight and thirteen years postoperatively. Lymph gland dissections are not performed prophylactically. When lymph glands are involved, modified neck dissection sufficient to remove all detectable carcinoma en bloc is performed. The sternocleidomastoid muscle and jugular vein are preserved except in the presence of extensive disease in the lateral part of the neck, in which case standard radical neck dissection is performed. The survival statistics presented herein compare favorably with those from other
640
Rickey and Howard
institutions. Deaths from papillary carcinoma are unusual after five years postoperatively [I]. Only two of our patients have died after five years. The average age at death of the patients with papillary carcinoma was sixty-six years. As is well known, carcinoma of the thyroid is more malignant in male patients. Of the twelve male patients in our series, six (50 per cent) are dead of the disease. The now standardized surgical treatment for cancer of the thyroid has improved the over-all five year survival rate from 75 per cent before 1956 to 84.2 per cent from 1956 through 1960. This is particularly true for papillary and follicular cancer for which the five year survival has been virtually 100 per cent, the only death occurring from cancer of the breast in a female patient with no evidence of recurrence of the papillary carcinoma of the thyroid.
SUMMARY
A series of 110 cases of carcinoma of the thyroid gland are reviewed. The surgical treatment, having been standardized for the past ten years, has resulted in a striking improvement in the survival statistics, particularly in patients with papillary or follicular carcinoma. REFERENCES
1. CRILE, G., JR., MCNAMARA,J. M., and HAZARD, J. B. Results of treatment of papillary carcinoma of the thyroid. Surg. Gynec. & Obst.,109: 315,1959. 2. BLACK, B. M., KIRK, T. A., JR., and WOOLNER, L. B. Multicentricity of papillary adenocarcinoma of the thyroid: influence on treatment. J. Cl&. Endocrinol., 20: 130, 1960. 3. CLARK, R. L., JR., WHITE, E. C., and RUSSELL,
W. D. Total thyroidectomy for cancer of the thyroid. Ann. Sung., 149: 858, 1959. 4, FRAZELL,E. L. and FOOTE,F. W., JR. Papillary cancer of the thyroid. Cancer, 11: 895, 1958.
American Journal of Surgery
of the Thyroid*
ORVILLE L. RICKEY, JR., M.D. AND ROBERT B. HOWARD, M.D., Oklahoma
From
St. Anthony Hospital, Oklahoma City, Oklahoma.
HE SURGICAL APPROACH to cancer of the
T thyroid
gland remains controversial. A variety of surgical procedures are recommended in the literature. There is a trend toward more radical excision of the thyroid gland and less radical treatment of the lymph glands of the neck. In this country the five and ten year survival rates for papillary carcinoma of the thyroid range from 74 to 94 per cent [1-P]. The thyroid gland is treated by unilateral lobectomy [I], total and subtotal lobectomy [Z], and total thyroidectomy [3]. Involved lymph glands of the neck are treated by radical neck dissection [P] or modified neck dissection to meet the requirement of adequate resection of the tumor in each case [I ]. The purpose of this paper is to present 110 cases of carcinoma of the thyroid gland not previously reported. These 110 cases occurred in a personal series of 1,595 thyroidectomies, a 6.9 per cent incidence of cancer. This series covers a twenty year period, and the surgical approach to the malignant lesions has been standardized for the past ten years. Current follow-up information is available on 108 patients (98.2 per cent). MATERIAL All patients were operated upon by one of us (R.B.H.). Table I presents the clinical evaluation of
the type of goiter. Carcinoma occurred primarily in patients with nodular nontoxic goiter (93 per cent). Table II presents the over-all survival statistics of
the 110 patients with carcinoma with regard to the pathologic classification; 65 per cent were papillary carcinomas. The over-all survival rate for patients with papillary carcinoma was 88.7 per cent. The over-all survival rate for those with follicular car* Presented
at the Eighteenth
cinoma was 88.9 per cent. Seventy-eight patients have been followed up five years or more and forty, ten years or more. Two patients lost to follow-up study had lived ten and thirteen years postoperatively and are included in the statistics as ten year survivors. A small number of lesions were classified as mixed papillary and follicular carcinomas and are considered herein according to the dominant cell type. The miscellaneous category includes seven lymphosarcomas, three Htirthle cell carcinomas, one schwannoma, and one scirrhous carcinoma. Table III lists the pathologic classification of the lesion of those seventy-eight patients followed up five years or more. Forty-four of these were papillary carcinomas, The ages of the seventy-eight patients at the time of diagnosis were as follows: ten to nineteen, six patients; twenty to twenty-nine, five; thirty to thirty-nine, sixteen; forty to forty-nine, twenty-two; fifty to fifty-nine, eleven; sixty to sixtynine, eleven; seventv to seventy-nine, six; eighty to eighty-nine, one patient. The surgical procedures performed on seventyeight patients followed up five years or more were as follows: total lobectomy and radical subtotal lobectomy, thirty-seven patients; total lobectomy and radical subtotal lobectomy with modified radical neck dissection, seven; total lobectomy and radical subtotal lobectomy with standard radical neck dissection, nine; unilateral total lobectomy, four; total thyroidectomy, seven; bilateral subtotal thyroidectomy, eleven; unilateral subtotal thyroidectomy, three. The variety of procedures exists because of the period of time covered (twenty years). During the past ten years surgical treatment of the thyroid gland has been total lobectomy on the primary side and radical subtotal resection of the opposite lobe. Lymph gland dissection is reserved for those patients with palpable suspicious lymph glands at surgery. Forty-four patients with papillary carcinoma in the group were followed up five years or more. The surgical procedures performed on these patients were as follows: total lobectomy and radical sub-
total lobectomy, twenty-one patients; total lobectomy and radical subtotal lobectomy with modified
Annual Meeting of the SouthwesternSurgicalCongress,Las Vegas, Nevada,
April 18-21, 1966.
Vol. 112. November
1966
City, Oklahoma
637
638
Rickey and Howard TABLE
INCIDENCE
OF
CARCINOMA
I
IN
TABLE
1,5%
THYROIDECTOMIES
HISTOLOGIC WITH
Total No. of No. with Patients Cancer
Clinical Diagnosis Diffuse toxic goiter Nodular toxic goiter Diffuse nontoxic goiter (thyroiditis, 78 cases) Nodular nontoxic goiter Total
301 235
2 4
87 972 1,595
2 102 110
radical neck dissection, four; total lobectomy and radical subtotal lobectomy with standard radical neck dissection for extensive jugular lymph gland metastases, four; unilateral total lobectomy, two; total thyroidectomy, four; bilateral subtotal thyroidectomy, five; unilateral subtotal thyroidectomy, four. Eight deaths occurred in the forty-four patients with papillary carcinoma. Three of these patients had palliative resections with either tracheal or esophageal invasion present at operation, and each died of the disease in less than five years. One patient died of carcinoma of the breast two years after thyroidectomy. Autopsy revealed no recurrence of the thyroid carcinoma. One patient survived five years only to die from pulmonary metastases. One patient survived twelve years and died from undifferentiated carcinoma of the thyroid. The preceding two patients who survived five and twelve years are included in the five and ten year survival statistics. Two other patients with curative resection died of the disease in two and four and a half years. The five year survival rate among those patients with resectable lesions is 92.5 per cent (thirty-eight of fortyone). The five year survival rate for the entire group of forty-four patients with papillary carcinoma is 86.4 per cent. Of the twenty-nine patients treated in the now standardized manner of total lobectomy plus radical subtotal lobectomy with or without neck dissection,
TABLE OVER-ALL
SURVIVAL
CANCER
Histologic Classification Papillary carcinoma Follicular carcinoma Undifferentiated carcinoma Miscellaneous Total
II
STATISTICS
OF
110
PATIENTS
WITH
OF THE THYROID
No. of Patients
No. of Deaths
Per cent of Survivors
71 18
8 2
88.7 88.9
9 12 110
7 5 22
22.3 58.3 80
CLASSIFICATION
CANCER
OF
THE THAN
III
OF SEVENTY-EIGHT
THYROID FIVE
FOLLOWED
PATIENTS UP
MORE
YEARS
Histologic Classification
No. of Patients
Per cent
Papillary carcinoma Follicular carcinoma Undifferentiated carcinoma Miscellaneous Total
44 19 8 7 78
56.5 24.3 10.2 9.0 100.0
only two patients have died, One died of cancer of the breast and the other of undifferentiated carcinoma recurring after twelve years. None has died of papillary carcinoma. Forty patients were treated before 1956. The five year survival rate among these patients is 75 per cent and the ten year survival rate, 72 per cent. The surgical procedures were not standardized during this period. Bilateral subtotal thyroidectomy or unilateral lobectomy was performed in seventeen patients, total thyroidectomy in six, and seventeen patients underwent total lobectomy with subtotal resection of the opposite side. Lymph node dissections were performed on seven occasions for involved glands. Thirty-eight patients were treated between 1956 and 1960. Thirty-five of these were treated in the now standard manner with total lobectomy and radical subtotal lobectomy of the opposite lobe. Six deaths occurred in this group from undifferentiated carcinoma in three, schwannoma in one, and lymphosarcoma in one. Only one patient with papillary or follicular carcinoma has died, death occurring two and a half years postoperatively from carcinoma of the breast, without evidence of recurrence of thyroid cancer. Two young female patients in the early group who presented with extensive disease bilaterally in the cervical lymph glands were treated with total thyroidectomy, standard radical neck dissection on the more extensively involved side, and modified neck dissection on the opposite side. One of these had pulmonary metastases when first examined. Both patients are alive and well twelve and fifteen years postoperatively. Pulmonary metastases are present on chest roentgenogram but unchanged in the past eight to ten years. All patients in this series were given suppressive doses of desiccated thyroid (2 to 3 gr. daily) postoperatively. Cobalt teletherapy has been used in those patients in whom the lesion was unresectable or extensive enough to cause doubt as to whether it had been completely removed. Radioactive iodine131 has been used in rare instances of functioning follicular lesions which were unresectable. AmericanJournal of Surgery
Cancer of Thyroid OPERATIVE
PROCEDURE
After exposure of the thyroid gland through the usual collar incision, each lobe is examined carefully along with the lateral part of the neck, paratracheal, and superior mediastinal node-bearing areas. If the Delphian lymph node is encountered, it is submitted for frozen section study. If node involvement is not detected, the lobe with the primary tumor (suspicious nodule) is treated by extracapsular total lobectomy with careful preservation of the recurrent laryngeal nerve and parathyroid glands whenever possible. Paratracheal lymph nodes are removed with this lobe whenever necessary. En bloc dissection is carried out across the isthmus into the opposite lobe or well beyond the nodule. This portion is submitted for frozen section study. If frozen section confirms the diagnosis of carcinoma, radical subtotal lobectomy is performed on the opposite side. After division of the superior thyroid vessels and middle thyroid vein, the lobe is rotated medially and the recurrent nerve identified and traced to the wing of the thyroid cartilage. A small portion of the thyroid capsule along the inferior thyroid vessels is left behind to assure parathyroid function. The lobe is removed leaving the fragment of capsule, thyroid parenchyma, and inferior parathyroid gland with its vascular pedicle. COMMENTS
The biologic activity of papillary carcinoma of the thyroid gland is very unlike that of other carcinomas. The slow sluggish rate of growth and late blood-borne metastases leave some room for conservatism in the surgical treatment of this lesion. Although local lymphatic spread may occur early and the cells grow luxuriantly in the lymph glands, often outgrowing the primary lesion, local invasion of surrounding tissues (esophagus and trachea) is a late occurrence. Surgical extirpation prior to local invasion gives excellent prospects for cure. The problems of multicentricity and intraglandular metastases have brought about a more radical approach to surgery of the thyroid gland itself. Some centers now recommend total thyroidectomy [P] although lobectomy alone is still considered adequate in other places [I ]. Extracapsular dissection of the entire thyroid gland is not to be taken Vol. 112, November 1966
639
lightly. The incidence of tetany after these procedures has been reported as high as 50 per cent. Permanent tetany is a disabling disease and is recently reported as occurring in 11.4 per cent of cases of total thyroidectomy [3]. Considering the relative benignancy of papillary carcinoma, one wonders if the cure cannot at times be worse than the disease, and if preservation of some parathyroid function should not be a paramount consideration. Recurrent nerve paralysis is also disabling and can, as a rule, be prevented. Knowledge of the anatomy of the area and careful identification and preservation of both nerves are essential. Attempts to minimize the complications and yet not compromise the chance for cure in this disease have led us to something less than bilateral extracapsular total thyroidectomy. The involved lobe is treated with extracapsular dissection but with careful identification and preservation of the recurrent laryngeal nerve and parathyroid glands whenever possible. The opposite lobe is treated with radical subtotal lobectomy. The purpose is to spare the parathyroid gland with its blood supply. To do this, the inferior thyroid vessels are preserved up to and including a rim of thyroid capsule. A small fragment of thyroid parenchyma remains within the capsule. Permanent tetany has not occurred in this series, and transient episodes of tetany have occurred in 3 per cent of the patients. Recurrent nerve injury has not occurred except when the nerve was involved with the tumor and then only unilaterally. Papillary and follicular carcinomas are treated surgically in the same manner. Undifferentiated carcinoma is resected as extensively as possible, but the survival rates are uniformly poor although two of the nine patients are living eight and thirteen years postoperatively. Lymph gland dissections are not performed prophylactically. When lymph glands are involved, modified neck dissection sufficient to remove all detectable carcinoma en bloc is performed. The sternocleidomastoid muscle and jugular vein are preserved except in the presence of extensive disease in the lateral part of the neck, in which case standard radical neck dissection is performed. The survival statistics presented herein compare favorably with those from other
640
Rickey and Howard
institutions. Deaths from papillary carcinoma are unusual after five years postoperatively [I]. Only two of our patients have died after five years. The average age at death of the patients with papillary carcinoma was sixty-six years. As is well known, carcinoma of the thyroid is more malignant in male patients. Of the twelve male patients in our series, six (50 per cent) are dead of the disease. The now standardized surgical treatment for cancer of the thyroid has improved the over-all five year survival rate from 75 per cent before 1956 to 84.2 per cent from 1956 through 1960. This is particularly true for papillary and follicular cancer for which the five year survival has been virtually 100 per cent, the only death occurring from cancer of the breast in a female patient with no evidence of recurrence of the papillary carcinoma of the thyroid.
SUMMARY
A series of 110 cases of carcinoma of the thyroid gland are reviewed. The surgical treatment, having been standardized for the past ten years, has resulted in a striking improvement in the survival statistics, particularly in patients with papillary or follicular carcinoma. REFERENCES
1. CRILE, G., JR., MCNAMARA,J. M., and HAZARD, J. B. Results of treatment of papillary carcinoma of the thyroid. Surg. Gynec. & Obst.,109: 315,1959. 2. BLACK, B. M., KIRK, T. A., JR., and WOOLNER, L. B. Multicentricity of papillary adenocarcinoma of the thyroid: influence on treatment. J. Cl&. Endocrinol., 20: 130, 1960. 3. CLARK, R. L., JR., WHITE, E. C., and RUSSELL,
W. D. Total thyroidectomy for cancer of the thyroid. Ann. Sung., 149: 858, 1959. 4, FRAZELL,E. L. and FOOTE,F. W., JR. Papillary cancer of the thyroid. Cancer, 11: 895, 1958.
American Journal of Surgery