Bakkar Sohail, Biricotti Marco, Stefanini Gianni, Ambrosini Carlo Enrico, Materazzi Gabriele, Miccoli Paolo
Division of Endocrine Surgery, Department of Surgical Pathology, University Hospital of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
Langenbecks Arch Surg. 2017 Aug;402(5):799-804. doi: 10.1007/s00423-016-1460-x. Epub 2016 Jun 23.
The optimal management of thyroglossal cyst carcinoma, particularly the extent of surgery required is controversial. The aim of this study was to evaluate the need for routinely adding total thyroidectomy to Sistrunk's operation in the management of this condition.
The clinical records of 19 patients with a diagnosis of thyroglossal cyst carcinoma encountered in an 11-year period (2004-2015) were reviewed. All patients underwent total thyroidectomy in addition to Sistrunk's procedure. The rate of concomitant thyroglossal cyst and thyroid carcinomas was calculated and cancers were staged according to the AJCC-TNM staging system. Patients were divided into two groups: those with thyroglossal cyst carcinoma only (group A) and those with a synchronous or metachronous thyroid carcinoma as well (group B). The need for radioactive iodine ablation in group A was assessed. The ability to omit total thyroidectomy based on thyroglossal cancer size and a negative thyroid ultrasound was also evaluated.
The rate of concomitant thyroid cancer was 63.2 % (12/19). Based on stage, three out of the seven patients in group A required radioactive iodine ablation. Total thyroidectomy was ultimately justifiable in 78.9 % (15/19) of cases. Omitting total thyroidectomy in T1 thyroglossal cyst cancers or based on a sonographically normal thyroid was associated with a 43 % risk of missing thyroid malignancy.
The routine addition of total thyroidectomy to Sistrunk's procedure seems to be appropriate for comprehensive loco-regional control especially that selecting a subset of patients in which it could be omitted is a difficult task.
甲状舌管囊肿癌的最佳治疗方案，尤其是所需手术范围存在争议。本研究旨在评估在该疾病的治疗中，常规在Sistrunk手术基础上加做全甲状腺切除术的必要性。
回顾了11年期间（2004 - 2015年）确诊为甲状舌管囊肿癌的19例患者的临床记录。所有患者除接受Sistrunk手术外，均接受了全甲状腺切除术。计算甲状舌管囊肿与甲状腺癌并存的发生率，并根据美国癌症联合委员会（AJCC）- TNM分期系统对癌症进行分期。患者分为两组：仅患有甲状舌管囊肿癌的患者（A组）和同时或异时患有甲状腺癌的患者（B组）。评估A组患者放射性碘消融的必要性。还评估了根据甲状舌管癌大小和甲状腺超声阴性而省略全甲状腺切除术的可行性。
甲状腺癌并存率为63.2%（12/19）。根据分期，A组7例患者中有3例需要放射性碘消融。最终，78.9%（15/19）的病例全甲状腺切除术是合理的。对于T1期甲状舌管囊肿癌或基于甲状腺超声正常而省略全甲状腺切除术，遗漏甲状腺恶性肿瘤的风险为43%。
在Sistrunk手术基础上常规加做全甲状腺切除术似乎适合进行全面的局部区域控制，特别是因为选择一部分可以省略该手术的患者是一项艰巨的任务。
