Purpose: The treatment of choice for well-differentiated thyroid cancer is surgical excision. However, the operation method is still controversial. Also, the operation method has been changing gradually. Thus, we reviewed the records of patients
with
well-differentiated thyroid cancer who had received operations in our hospital to assess the trend in surgical procedure, and to determine the proper procedure, method, considering both recurrence and complications. Methods: We retrospectively
analyzed
the cases of 452 patients with differentiated thyroid cancer who had received operations from January 1989 to December 1998. We divided the 10 years into two periods; period I was from 1989 to 1993 (254 patients) and period II was from 1994 to
1998
(198
patients). We analyzed recurrences and complications according to the operation method, including neck lymph-node dissection. The incidences and locations of lymph- node metastasis were taken into account, too. The statistical analysis was done
by
using
the Fisher's exact test. Results: In period I, 147 patients (58%) received a total thyroidectomy, and in period II, all patients received total thyroidectomy. In period I, 24 patients (9.4%) had a recurrence, and in period II, 13 patients (6.6%)
had a
recurrence. In period I, 55 patients (21.7%) had postoperative hypoparathyroidism, and in period II, 38 patients (19.2%) had postoperative hypoparathyroidism. In period I, 15 patients (5.9%) had postoperative hoarseness, and in period II, 7
patients
(3.5%) had postoperative hoarseness. Two hundred eighty-one patients (62.2%) had lymph-node metastasis, and the anterior neck region was the most common site of metastasis (60.2%). Conclusion: In the operation method for differentiated thyroid
cancer,
the trend is toward a total thyroidectomy away from a lobectomy. Also, a skillful and experienced surgeon can reduce the incidence of postoperative complications. Thus the best operation method for differentiated thyroid cancer is a total
thyroidectomy,
including a preventive anterior-neck lymph-node dissection, which is done by a skillful and experienced surgeon.
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