overview of thyroid cancer management in Kuwait cancer control centre [1992-1998]

thyroid cancer in Kuwait is the second most common malignant neoplasm after breast cancer in females. This retrospective single-institution study aims at assessing the different surgical treatment options offered to thyroid cancer patients presenting to Kuwait Cancer Control Centre [KCCC] between March 1992 and June 1998 and evaluating patients outcome. Patients and a total of 197 consecutive patients with clinicaly suspicious thyroid nodules were primarily treated by surgery at KCCC in the above mentioned period; 86 [44%] patients were proved have thyroid malignancy. Clinical characteristics, histological features, prognostic factors, the impact of various surgical procedures on patient outcome along with treatment-related morbidities were all analysed. fifty-nine patients were females and 27 males. The majority of our patients were below the age of 45 years, while 25 were at the age of 45 or above. The mean age was 40 years. Sixty-two [72%] patients presented with true solitary thyroid nodules. Eleven [13%] patients had distant metastasis at presentation. In this series, there was no underlying toxic goitre of Hashimoto's disease. Adequate information for cancer staging, according to the Internation Union Against Cancer [UICC-TNM] classification, was available in 54 [63%] patients. The most common histological type was papillary carcinoma, documented in 74 [86%] patients. The type and extent of thyroid surgery were planned according to the age at the time of initial diagnosis, histological tumour type, size and presence of extra-thyroid invasion, sixty-five [76%] patients had total extracapsular thyroidectomy, 12 [14%] near total thyroidectomy, 7 [8%] ipsilateral total lobectomy and isthmectomy and 2 [2%] contralateral thyroid lobetomy. Different types of therapeutic neck dissections were carried out in 48 [56%] cases. Following surgery, 4 [5%] patients had chronic shoulder pain syndrome, 5 [6%] patients had transient hypocalcaemia, 3 [3%] permanent hypocalcaemia, and 5 [6%] unilateral temporary paresis of the recurrent laryngeal nerve [RLN]; in one patient, the RLN was sacrificed on one side due to an extensive tumour growth. total thyroidectomy remains the treatment of choice for patient with differentiated thyroid carcinoma, due to its excellent local control with a minimal morbidity rate. However, ipsilateral thyroid lobectomy and isthmectomy can be recommended for young, low-risk patients. Patients with palpable medullary thyroid carcinoma should have an aggressive surgical treatment in the form of total thyroidectomy with routine central lymph node clearance and bilateral functional neck dissections

role of cervical lymph node dissection in the management of thyroid cancer

The aim of this study is to establish the frequency, pattern and location of cervical lymph node metastases from thyroid cancer and to recommend the appropriate type and extent of neck dissection. Patients and The medica records of 86 patients operated upon for primary thyroid cancer at Kuwait Cancer Control Centre [KCCC] between March 1992 and June 1998 were retrospectively analysed; 48 patients had therapeutic cervical lymph node dissection [TCLND], either during the primary thyroid surgery [immediate] or at a later data [delayed]. The different forms of TCLND employed were functional, radical, central and selective. The pattern and level of lymph node metastasis were the main consideration deciding the type and extent of neck dissection. Forty-sis neck dissections were done synchronously with the primary thyroid surgery, while 2 had the neck dissection at a separate session. Twenty male and 28 female patients were offered TCLND. The age at initial presentation ranged from 11 to 88 years, with a mean age of 42 years. The primary lesions were papillary and medullary thyroid carcinomas in 43 and 5 patients, respectively. Ipsilateral functional neck dissection was carried out in 21 patients, while central neck clearance radical neck clearance was performed in 6 cases; 14 patients were offered and 5 had selective neck dissection; only patients had bilateral functional block. Forty-one patients were followed up for a period ranging from 3 to 9 years, with a mean of 3.2 years. The commonest postoperative complication was shoulder disability syndrome in 4 patients; one patient died on the third postoperative day due to cerebral haemorrhage. Recurrence of the disease following neck dissection was noted in 3 patients. A well-done functional neck dissection, concomitantly performed at the time of the initial thyroid cancer patients [mainly papillary carcinomas], having clinically suspicious and histological involved neck nodes by metastatic disease. On the other hand, for all patients with palpable medullary carcinoma, routine central and bilateral functional neck dissections should be considered. This aggressive approach reduces subsequent recurrences and the need for repeated surgeries and prevents the increasing morbidity of multiple operations for recurrent nodal disease