甲状腺叶切除术或甲状腺全切除术——分化型甲状腺癌的治疗方向在哪里？

Lobectomy or Total Thyroidectomy-Where Is the Pendulum now for Differentiated Thyroid Cancer?

机构信息

Divsion of General, Endocrine and Metabolic Surgery, University of Kentucky, Lexington, KY 40508, USA; General, Endocrine & Metabolic Surgery, University of Kentucky, 125 East Maxwell Street, Suite 302, Lexington, KY 40508, USA.

Divsion of General, Endocrine and Metabolic Surgery, University of Kentucky, Lexington, KY 40508, USA; Department of Surgery, University of Kentucky College of Medicine, UK HealthCare, 800 Rose Street, MN268, Lexington, KY 40508, USA.

出版信息

Surg Oncol Clin N Am. 2023 Apr;32(2):373-381. doi: 10.1016/j.soc.2022.10.011.

DOI:10.1016/j.soc.2022.10.011

PMID:36925191

Abstract

Thyroid surgery remains an essential treatment of thyroid cancer. The historical one-size-fits-all approach to differentiated (papillary and follicular) thyroid carcinoma of total thyroidectomy with central lymph node dissection has been shown to be overtreatment with associated risk of perioperative complications including nerve palsy and hypoparathyroidism. Furthermore, thyroid lobectomy may obviate life-long thyroid hormone replacement. Low-risk thyroid cancers have a low risk of recurrence and those that do recur can be salvaged with reoperation without compromising prognosis. Perioperative risk stratification for recurrence and death greatly influence the need for total thyroidectomy.

摘要

甲状腺手术仍然是甲状腺癌的重要治疗方法。历史上，全甲状腺切除术加中央淋巴结清扫术的一刀切方法被证明是过度治疗，与围手术期并发症（包括神经麻痹和甲状旁腺功能减退）相关的风险。此外，甲状腺叶切除术可能避免终身甲状腺激素替代治疗。低风险的甲状腺癌复发风险低，且那些复发的癌症可以通过再次手术挽救，而不会影响预后。复发和死亡的围手术期风险分层对全甲状腺切除术的需求有很大影响。