Simon D, Goretzki P E, Witte J, Röher H D
Department of Surgery, Heinrich Heine University Düsseldorf, Moorenstrasse 5, D-40225 Düsseldorf, Germany.
World J Surg. 1996 Sep;20(7):860-6; discussion 866. doi: 10.1007/s002689900131.
Total thyroidectomy has become the routine procedure for treatment of differentiated thyroid carcinoma. However, the necessity of unilateral or bilateral neck dissection is far less standardized. Our usual procedure has been to perform a routine neck dissection in T4 tumors and in all other tumor stages only in the presence of positive diagnostic or intraoperative findings. The results concerning regional tumor recurrence in cervical lymph nodes subsequent to thyroidectomy are studied and discussed. Between April 1986 and December 1992 a group of 252 patients were operated on for differentiated thyroid carcinoma (DTC) (176 papillary, 76 follicular). Postoperative treatment included radioiodine therapy as a rule in all patients more than stage T1, and follow-up encompassed thyroglobulin measurements, cervical ultrasonography, and radioiodine scintigraphy. After a mean follow-up of 6.9 years, 77 (31%) of the patients underwent reoperation because of regional tumor recurrence [46 of 176 (26%) papillary, 31 of 76 (41%) follicular]. In papillary thyroid cancer a significant difference could be demonstrated between patients with thyroidectomy only versus thyroidectomy plus neck dissection in all tumor stages (T2, 13 of 29 (45%) versus 1 of 34 (3%); T3, 10 of 13 (77%) versus 4 of 11 (36%); T4, 6 of 8 (75%) versus 6 of 18 (33%) (p < 0.0001). Similar results could be achieved for follicular thyroid cancer, showing statistical significance with regard to operative procedure (p < 0.009). Our experience demonstrates a positive correlation of regional tumor recurrence with increasing tumor stage for both histologic tumor types. The high rate of regional recurrence justifies a more radical approach, including neck dissection at the initial operation. The impact on survival, however, must be proved by further evaluation.
全甲状腺切除术已成为分化型甲状腺癌的常规治疗方法。然而，单侧或双侧颈部清扫术的必要性却远未标准化。我们通常的做法是，对于T4期肿瘤以及所有其他肿瘤分期，仅在诊断或术中发现阳性结果时才进行常规颈部清扫术。本文对甲状腺切除术后颈部淋巴结区域肿瘤复发的结果进行了研究和讨论。1986年4月至1992年12月期间，一组252例患者接受了分化型甲状腺癌（DTC）手术（176例乳头状癌，76例滤泡状癌）。术后治疗通常包括对所有T1期以上的患者进行放射性碘治疗，随访包括甲状腺球蛋白测量、颈部超声检查和放射性碘闪烁扫描。平均随访6.9年后，77例（31%）患者因区域肿瘤复发接受了再次手术[176例乳头状癌中的46例（26%），76例滤泡状癌中的31例（41%）]。在乳头状甲状腺癌中，所有肿瘤分期（T2期，29例中的13例（45%）对34例中的1例（3%）；T3期，13例中的10例（77%）对11例中的4例（36%）；T4期，8例中的6例（75%）对18例中的6例（33%））中，单纯甲状腺切除术患者与甲状腺切除术加颈部清扫术患者之间存在显著差异（p < 0.0001）。滤泡状甲状腺癌也能得到类似结果，在手术方式方面具有统计学意义（p < 0.009）。我们的经验表明，对于这两种组织学肿瘤类型，区域肿瘤复发与肿瘤分期增加呈正相关。区域复发率高证明了一种更激进的方法是合理的，包括在初次手术时进行颈部清扫术。然而，对生存的影响必须通过进一步评估来证实。
