Miccoli Paolo, Bakkar Sohail
Division of Endocrine Surgery, Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
Department of Surgery, Faculty of Medicine, The Hashemite University, Zarqa, 13133, Jordan.
Updates Surg. 2017 Jun;69(2):145-150. doi: 10.1007/s13304-017-0449-5. Epub 2017 Apr 12.
The surgical management of papillary thyroid carcinoma remains contentious and the optimal surgical strategy has not been yet established. The extent of thyroid resection has been the nub of this debate. Literature lacks prospective randomized controlled trials that could help put this debate to rest, and these have been labeled as being impractical. Consequently, large retrospective studies and expert opinion have constituted the basis of clinical practice guidelines. Recent American Thyroid Association and National Comprehensive Cancer Network guidelines consider a conservative approach in the form of a thyroid lobectomy sufficient for low-risk disease and that total thyroidectomy remains the standard of care in the presence of high-risk features. Nevertheless, many authorities still advocate more aggressive therapy for low-risk disease. The challenge in standardizing the surgical strategy to papillary thyroid carcinoma is mainly related to a major tumor characteristic: the high frequency of occult cancerous foci whether within the thyroid gland itself or within loco-regional lymph nodes as this tumor characteristic has been incriminated for a higher risk of recurrent disease and its adverse sequelae. The purpose of this article is to provide an overview of the surgical management of papillary thyroid carcinoma and the main arguments surrounding this hotly debated topic. All evidences for this review article were drawn from PubMed articles in English language mostly cross-referenced with international guideline statements.
甲状腺乳头状癌的外科治疗仍存在争议，最佳手术策略尚未确立。甲状腺切除范围一直是这场争论的核心。文献中缺乏有助于平息这场争论的前瞻性随机对照试验，这些试验被认为不切实际。因此，大型回顾性研究和专家意见构成了临床实践指南的基础。美国甲状腺协会和美国国立综合癌症网络最近的指南认为，对于低风险疾病，采用甲状腺叶切除术这种保守方法就足够了，而在存在高风险特征的情况下，全甲状腺切除术仍是标准治疗方法。然而，许多权威人士仍然主张对低风险疾病采取更积极的治疗方法。将甲状腺乳头状癌的手术策略标准化面临的挑战主要与一个主要肿瘤特征有关：隐匿性癌灶在甲状腺本身或局部区域淋巴结中的高发生率，因为这种肿瘤特征被认为会增加疾病复发及其不良后果的风险。本文的目的是概述甲状腺乳头状癌的外科治疗以及围绕这个激烈争论话题的主要观点。这篇综述文章的所有证据均来自大多与国际指南声明相互参照的英文PubMed文章。
