The pros and cons of lymphadenectomy in papillary and follicular thyroid carcinomas
Summary
Patients with papillary and follicular thyroid carcinomas are said to have an excellent long-term prognosis. However, over 90 % of papillary carcinomas have synchrone lymphnode metastases. Based on clinical, histopathologic and molecular-biological factors, different patient groups can be defined with an increased recurrence rate and disease related mortality-rate of up to 50 % in the long-term follow-up of 30 years. Therefore, not only the extent of the surgical resection of the thyroid cancer but also the lymphnode dissection as an oncologic correct surgical procedure is of great importance. Although the position of surgical lymphadenectomy is still discussed controversially there are increasing reasons to support the concept of a radical initial operation following the rules of oncologic surgery. We consider total thyroidectomy and modified neck-dissection as the standard operation in well differentiated thyroid carcinoma. In unilateral carcinoma both the central and the ipsilateral cervico-lateral lymphnode compartments are dissected. In multicentric bilateral carcinomas a bilateral cervico-central and cervico-lateral lymphadenectomy has to be performed.
Zusammenfassung
Papilläre und follikuläre Schilddrüsenkarzinome gelten als Malignome, welche eine ausgezeichnete Langzeitprognose aufweisen. Insbesondere papilläre Schilddrüsenkarzinome haben jedoch in > 90 % Lymphknotenmetastasen. Aufgrund verschiedener klinischer, histopathologischer und molekularbiologischer Faktoren lassen sich Patientengruppen mit erhöhter Rezidiv- und Mortalitätsrate definieren, welche im Langzeitverlauf von > 30 Jahren eine tumorbedingte Mortalität von 50 % aufweisen. Deshalb ist für die chirurgische Therapie nicht nur das Ausmaß der Schilddrüsenresektion wesentlich, sondern ebenfalls eine Lymphknotendissektion notwendig, um eine onkochirurgisch korrekte Tumorresektion zu erreichen. Obwohl der Stellenwert der Lymphknotendissektion immer noch umstritten ist und die Datenlage in der Literatur teilweise kontrovers erscheint, gibt es genügend Gründe, das Konzept der radikalen Erstoperation, welche alle onkochirurgischen Kriterien erfüllt zu propagieren. Die Standardoperation beim differenzierten Schilddrüsenkarzinom beinhaltet die totale Thyreoidektomie und eine modifizierte Neck-dissektion. Bei einseitigen Karzinomen werden die ipsilateralen zervikolateralen und zerviko-medialen Lymphknoten, im Falle eines multizentrischen, bilateralen Karzinomes werden beidseits die zervikolateralen und zervikozentralen Lymphknotenkompartimente entfernt.
Key words
Thyroid cancer - lymphnode metastases - lymphnode dissection - mortality
Schlüsselwörter
Schilddrüsenkarzinom - Lymphknotenmetastasen - Lymphadenektomie - Mortalität
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