ty way. One should also note the patient follow-up and the justification for the conclusions that seem to be par- ticularly well founded.

REFERENCES 1. Strong E, Guillamondegui 0. Papillary cancer of the thyroid. Contemp Surg 1988; 32: 107-23. 2. Saaman N. Impact of therapy for differentiated carcinoma of the thyroid: an analysis of 706 cases. J Clin Endocrinol Metab 1983; 56: 1131-8. 3. Chonkich G. Total thyroidectomy in the treatment of thyroid

EDITORIAL COMMENT

disease. Laryngoscope 1987; 97: 897-900. 4. Ward P. The surgical treatment of thyroid cancer. Arch Otolar- yngol Head Neck Surg 1986; 112: 1204-6. 5. Guillamondegui 0, Mikhail RA. The treatment of differentiated carcinoma of the thyroid gland. Selective management? Arch Oto- laryngol 1983; 109: 743-S. 6. Leight GS. Nodular goiter and benign and malignant neoplasms of the thyroid. In: Sabiston D, ed. Textbook of surgery, 13th ed. Philadelphia: WB Saunders, 1986: 602-7. 7. Kaplan E. Thyroid and parathyroid. In: Schwartz S, ed. Princi- ples of surgery, 4th ed. New York: McGraw-Hill, 1984: 1568-77. 8. Cady B. Further evidence of the validity of risk group definition in differentiated thyroid carcinoma. Surgery 1985; 98: 1171-8.

Hiram C. Polk, Jr., MD, Louisville, Kentucky

The accompanying study is both published and deserving of comment for two main reasons. First, for many years, I have been concerned about the degree to which papers that ap- pear in the literature represent main- stream surgical practice, particularly as they relate to complications and death rates. It has been my prejudice that there is a tendency toward re- porting a very good result from an

From the Department of Surgery, University of Louisville, Louisville, Kentucky.

experienced and established center on the part of a surgeon with great expertise in a narrow illness. Con- versely, I feel that what has been uni- formly lacking in much of the surgi- cal literature are truly representative reports from the real world of surgi- cal practice.

The preceding study reflects a very high level of technical accom- plishment on the part of the rank- and-file general surgeon conducting thyroid surgery at Camp Lejeune. Furthermore, it provides some inter-

esting insights, though of less than ideal duration, using a military tu- mor board system that provides the long-term follow-up that is requisite in patients with thyroid cancer. I think both lessons speak for them- selves, but the development of reports that are truly representative of the superb results that attend usual sur- gical practice for common illnesses will be more and more needed in a time in which our skills are progres- sively denigrated both scientifically and financially.

398 THE AMERICAN JOURNAL OF SURGERY VOLUME 158 NOVEMBER 1989