Department of General, Visceral and Vascular Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06097, Halle, Saale, Germany.
Langenbecks Arch Surg. 2013 Mar;398(3):347-75. doi: 10.1007/s00423-013-1057-6. Epub 2013 Mar 3.
Over the past years, the incidence of thyroid cancer has surged not only in Germany but also in other countries of the Western hemisphere. This surge was first and foremost due to an increase of prognostically favorable ("low risk") papillary thyroid microcarcinomas, for which limited surgical procedures are often sufficient without loss of oncological benefit. These developments called for an update of the previous practice guideline to detail the surgical treatment options that are available for the various disease entities and tumor stages.
The present German Association of Endocrine Surgeons practice guideline was developed on the basis of clinical evidence considering current national and international treatment recommendations through a formal expert consensus process in collaboration with the German Societies of General and Visceral Surgery, Endocrinology, Nuclear Medicine, Pathology, Radiooncology, Oncological Hematology, and a German thyroid cancer patient support organization.
The practice guideline for the surgical management of malignant thyroid tumors includes recommendations regarding preoperative workup; classification of locoregional nodes and terminology of surgical procedures; frequency, clinical, and histopathological features of occult and clinically apparent papillary, follicular, poorly differentiated, undifferentiated, and sporadic and hereditary medullary thyroid cancers, thyroid lymphoma and thyroid metastases from primaries outside the thyroid gland; extent of thyroidectomy; extent of lymph node dissection; aerodigestive tract resection; postoperative follow-up and surgery for recurrence and distant metastases.
These evidence-based recommendations for surgical therapy reflect various "treatment corridors" that are best discussed within multidisciplinary teams and the patient considering tumor type, stage, progression, and inherent surgical risk.
在过去的几年中，不仅在德国，而且在西半球的其他国家，甲状腺癌的发病率都在上升。这种上升首先是由于预后良好的（“低风险”）甲状腺乳头状微小癌的增加，对于这些癌症，通常只需进行有限的手术即可，而不会影响肿瘤的疗效。这些发展情况要求对以前的实践指南进行更新，以详细说明针对各种疾病实体和肿瘤分期的可用手术治疗选择。
德国内分泌外科医师协会目前的实践指南是基于考虑到当前国家和国际治疗建议的临床证据，通过与德国普通和内脏外科医师协会、内分泌学会、核医学学会、病理学学会、放射肿瘤学会、肿瘤血液病学会以及一家德国甲状腺癌患者支持组织合作的正式专家共识过程制定的。
恶性甲状腺肿瘤手术管理实践指南包括有关术前检查；局部区域淋巴结的分类和手术程序术语；隐匿性和显性甲状腺乳头状癌、滤泡状癌、低分化癌、未分化癌、散发性和遗传性髓样癌、甲状腺淋巴瘤和甲状腺外原发灶转移的甲状腺癌、甲状腺癌的频率、临床和组织病理学特征；甲状腺切除术的范围；淋巴结清扫术的范围；呼吸道切除；术后随访以及复发和远处转移的手术。
这些基于循证的手术治疗建议反映了各种“治疗途径”，最好在多学科团队和考虑肿瘤类型、分期、进展和固有手术风险的患者中进行讨论。
