Stump recurrence and total thyroidectomy in papillary thyroid cancer

HE purpose of this paper is to describe T briefly the pathology of stuinp recurrence after operations for locally malignant thyroid cancers and to examine the case for total thyroidectoniy versus unilateral lobectomy, resection-cnucleation, and lesser 11rocedures.T h e terms "papillary", "follicular", and "tin- differentiated" thyroid cancers arc used hcrc i n the same sense as by Warren and R.leissner.sT h c expression "stump recurrence" iiitlicates recurrent carcinoma in the fragnient 0 1 gland remaining after inconiplcte 1ol)ectoiny.I t presents special features of interest a i i d iinportancc.Also, the possibility of stump recurrence inevitably raises the cluestion ol' post-operative irradiation.What, we may ask, are the potential benefits and hazards of such prophylactic radiation therapy?STATEMENT OF PROBLEM A stump recurrence is hardly to be clistinguished from recurrence at the thyroid site and therefore the problem OI stump rccurience is intimately bound u p not only with the modes of intraglandular spread ol thyroid cancers and methods of removing them but also with their manner of involving lo( a1 structures.T h e preferred routes of spread for the chief pathological types are listed in Table 1.I are concerned here mainly with papillary cancers.With follicular carcinoma, granted wide excision, the principal risk is of haematogenous metastasis to bone or lung.Again, stump recui rente is hardly a pi oblcin with undifferentiated thyroid cancers, which, because o€ their extremely rapid gi owth and spread, iarely admit of attempts at extirpative surgery.Ry contrast, papillary canccrs usually run an indolent coui re.Even in the terminal stages they may remain confined to the neck.