Surgical Management of Locally Advanced Thyroid Cancer in the North West Zone: A 10-Year Cohort Analysis

Locally advanced thyroid cancer presents significant surgical challenges due to invasion of adjacent structures and carries a poorer prognosis than early-stage disease. In North West Nigeria, late presentation predominates, yet no contemporary cohort analysis of surgical management and outcomes exists. This study provides a 10-year cohort analysis of locally advanced thyroid cancer management at teaching hospitals in Kano, Sokoto, and Kebbi states from 2013 to 2023. A retrospective cohort of 95 patients with T4 thyroid cancer was assembled. Variables analyzed included histological subtype, degree of laryngotracheal and vascular invasion, surgical procedure performed, use of adjuvant radioiodine or external beam radiotherapy, disease-specific survival, and recurrence rates. Papillary thyroid carcinoma accounted for 64% of cases. Total thyroidectomy with laryngotracheal shave was performed in 51% of patients, while laryngectomy was required in 14%. Disease-specific 5-year survival was 48%, improving to 61% in patients who received adjuvant radioiodine. Unresectable disease was documented in 22% of cases. The study identifies significant treatment gaps including lack of radioiodine facilities in the North West and inadequate multidisciplinary thyroid cancer teams. Recommendations include establishment of a regional thyroid cancer centre, radioiodine treatment facility, and structured endocrine oncology training program. Keywords: thyroid cancer, locally advanced, North West Nigeria, surgical management, survival