Department of General, Visceral and Transplant Surgery, Tuebingen University Hospital, Hoppe-Seyler Str. 3, 72076, Tuebingen, Germany.
Department of Nuclear Medicine and Clinical Molecular Imaging, University Hospital Tuebingen, Tuebingen, Germany.
World J Surg Oncol. 2017 Oct 24;15(1):190. doi: 10.1186/s12957-017-1261-x.
The surgical resection extension in well-differentiated thyroid cancer is controversially discussed with the possibility of an overtreatment on the one hand against the risk of local disease recurrence. The aim of this study is to evaluate how the surgical resection extension with the adjunction of radioiodine therapy affects postoperative morbidity and the oncologic outcome of patients primarily treated for well-differentiated thyroid cancer.
All patients undergoing primary surgery for a well-differentiated, non-recurrent thyroid cancer from January 2005 to April 2013 at Tuebingen University Hospital were retrospectively analyzed.
Papillary thyroid cancer (PTC) was present in 73 patients (including 27 papillary microcarinoma) and follicular thyroid cancer in 14 patients. Fifty-six of 87 patients (64%) underwent one-stage surgery, of which 26 patients (30%) received simultaneous lymph node dissection (LND). The remaining 31 patients (36%) underwent a two-stage completion surgery (29 patients with LND). Only in three patients a single lymph node metastasis was newly detected during two-stage completion surgery. Patients with LND at either one-stage and two-stage completion surgery had a significant higher rate of transient postoperative hypocalcemia. Postoperative adjuvant radioiodine therapy was performed in 68 of 87 patients (78%). After a median follow-up of 69 months [range 9-104], one local recurrence was documented in a patient suffering from PTC 23 months after surgery.
No prophylactic two-stage lymphadenectomy should be performed in case of well-differentiated thyroid cancer to avoid unnecessary complication without any proven oncologic benefit.
在分化型甲状腺癌中，手术切除范围的扩大存在争议，一方面存在过度治疗的可能，另一方面存在局部疾病复发的风险。本研究旨在评估在分化型甲状腺癌患者的主要治疗中，手术切除范围的扩大并附加放射性碘治疗对术后发病率和肿瘤学结果的影响。
回顾性分析 2005 年 1 月至 2013 年 4 月在图宾根大学医院接受初次手术治疗的分化型、非复发性甲状腺癌患者。
73 例患者为甲状腺乳头状癌（PTC）（包括 27 例微小乳头状癌），14 例为滤泡状甲状腺癌。87 例患者中有 56 例（64%）行一期手术，其中 26 例（30%）行同期淋巴结清扫术（LND）。其余 31 例（36%）行两期完成手术（29 例行 LND）。仅在 3 例患者中，在两期完成手术中发现新的单个淋巴结转移。一期和两期完成手术行 LND 的患者术后出现短暂性低钙血症的发生率显著较高。87 例患者中有 68 例（78%）行术后辅助放射性碘治疗。术后中位随访时间为 69 个月（范围 9-104 个月），1 例 PTC 患者在术后 23 个月发生局部复发。
对于分化型甲状腺癌，不应预防性行两期淋巴结清扫术，以避免不必要的并发症，同时没有任何明确的肿瘤学获益。
