Lymphadenectomy in Papillary Thyroid Cancer

Česká verzia

Authors: B. Dudešek; J. Gatěk ; J. Duben; L. Hnátek; J. Kotoč; K. Kotočová; P. Vážan ^*
Authors place of work: Chirurgické oddělení, Nemocnice ATLAS a. s., Zlín, Univerzita Tomáše Bati ve Zlíně přednosta: prim. MUDr. Jiří Gatěk, Ph. D. ; Bioptická a cytologická laboratoř, vedoucí lékař MUDr. Josef Velecký ^*
Published in the journal: Rozhl. Chir., 2010, roč. 89, č. 9, s. 543-547.
Category: Monothematic special - Original

Summary

Introduction:
Papillary carcinoma is the most frequent malign tumour of the thyroid with rising incidence and metastasising in lymphatic veins.

Aim:
Diagnosing our patients and comparing the TNM stages to metastases found in lymphatic nodes.

Materials, methods: A retrospective study of 1,353 patients treated at our department between 2005 and 2008.

Results:
220 (16.3%) malign thyroid tumours have been found among 1,353 patients. Papillary carcinoma has been found in 180 cases, according to the TNM classification T1mic 80x (44.4%), T1 58x (32.2%), T2 29x (16.1%), T3 8x (4.4%), T4 5x (2.8%). Multifocal incidence of papillary carcinoma has been observed in 42 patients (23.3%). Lymphadenectomy cervicocentral 18x, ipsicervicolateral 52x, contracervicolateral 1x. In total, 351 nodes were removed and 113 nodes had metastasis of papillary carcinoma. 2 patients had permanent paresis of the NLR (1.11%), nerve at risk 0.56%, transitory paresis 5.56%.

Conclusion:
The basic surgical treatment of the thyroid with papillary carcinoma is total thyroidectomy with cervicocentral lymphadenectomy. Ipsilateral lympadenectomy is indicated in the case of nodes found sonographically or tumour size T2.

Key words:
papillary carcinoma of the thyroid – total thyroidectomy – lymphadenectomy

Zdroje

1. Gerharz, C. D. Maligne Schilddrüsenturmore. se 123, Siewert J. R., Rothmund M., Schumpelick V., Praxis der Viszeralchirurgie (Endokrine Chirurgie), Heidelberg 2007.

2. Dvořák, J. Rakovina štítné žlázy. Praha 1997, s. 63–64.

3. Vorländer, C., Lienenlüke, R. H., Wahl, R. A. Lymphknotendissektion beim papillären und follikulären Schilddrüsenkarzinom. Chirurg, 2008, 79, s. 564–570.

4. Wolf, H., Schimpfle, B. Die chirurgische Therapie des Schilddrüsenkarzinoms. Zentr. bl. Chir., 1989, 114, s. 1202–1208.

5. Goretzki, P., Dotzenrath, C. Differenzierte Schilddrüsenkarzinome. s. 131–146, Siewert J. R., Rothmund M., Schumpelick V. Praxis der Visceralchirurgie (Endokrine Chirurgie), Springer 2007.

6. Ryška, A. Co je nového v patologii štítné žlázy. Čes.-slov. Patol., 2008, 44, No. 4., s. 90–95.

7. Němec, J., a spol. Tyreoidální onkologie, Závěrečná zpráva o řešení grantu IGA MZ ČR 1995, registrační číslo 1429-3.

8. Dralle, H., Machens, A., Brauckhoff, M., Ukkat, J., Sekulla, C., Nguyen-Thanh, P., Lorenz, K., Gimm, O. Chirurgie der Schilddrüsenkarzinome. Onkologie, 2005, 11, s. 58–69.

9. Dralle, H., Gimm, O. Lymphadenektomie beim Schilddrüsencarcinom. Chirurg, 1996, 67, s. 788–806.

10. Pisanu, A., Reccia, I., Nardello, O., Uccheddu, A. Risk Factors for Nodal metastasis and recurrence Amog patiens with Papillary Thyroid Mirocarcinoma: Differences in Clinical relevance between Nonincidental and Inciental Tumors. World J. Surg., 2009, 33, s. 460–468.

11. Rosai, J. Rosai and Ackerman‘s Surgical Pathoogy. Mosby New York, 2004, 2970.

12. Roh, J. L., Kim, J. M., Park, C. I. Central cervical nodal metastasis from papillary thyroid microcarcinoma : pattern and factors predictive of nodal metastasi. Ann. Surg. Oncol., 2008, 15(9), s. 2482–2486.

13. Roti, E., degli Uberti, E. C., Bondanelli, M., Braverman, L. E. Thyroid papillary microcarcinoma: a descriptive and meta-analysis study. Eur. J. Endocrinol., 2008, 159(6), s. 659–673.

14. AACE/AAES Medical /Surgical Guidelines for Clinical Practice: Management of Thyroid Carcinoma. Endocrine Practice, 2001, 7(3), s. 202–220.

15. Thomusch, O., Sekulla, C., Dralle, H. Rolle der Totalen Thyreoidektomie im primären Therapiekonzept der benignen Knotenstruma. Chirurg, 2003, 74, s 437–443.

16. Wada, N., Duh, Q.-Y., Sugino, K., Iwasaki, H., et al. Lymf Node Metastasis From 259 Papillary Thyreoid Microcarcinomas: Frequancy, Pattern of Occurence and Reccurence, and Optimal Stretegy for Neck Dissection. Annals of Surgery, 2003, 237, s. 399–407.

17. Scheidt, A., Käufer, C. Stellenwert der zweizeitigen Thyreoidektomie beim Schilddrüsenkarzinom. Akt. Chir., 1992, 27, s. 121–125.

18. Hay, I. D., Mc Conahey, W. M., Goellner, J. R. Managing Patients with Papillary Thyroid carcinoma: Insights Gained from The Mayo Clinics‘ Experience of Traiting 2,512 Consecutive Patients During 1940 Through 2000. Trans. Am. Clin. Climatol., 2002, 113, s. 241–260.

19. Bilimorie, K. Y., Bentrem, D. J., Ko, C. Y., Stewart, A. K., Winchester, D. S., Talamonti, M. S., Sturgeon, A. K. Extent of Surgery Affects Survival for Papillary Thyroid Cancer. Ann. Surg., 2007, 246(3), 375–384.

20. Giulliano, A., Dale, P., Turner, R., Morton, D., Evans, S., et al. Improved Axillary Staging of Breast Cancer with Sentinel Lymphadenectomy. Ann. Surg., 1995, 222, s. 394–401.

21. Motomura, K., Komoike, Y, Inaji, H., et al. Multiple sectioning and immunohistochemical staining of sentinel nodes in patiens with breast cancer. Br. J. Surg., 2002, 89, 1032–1034.