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Das differenzierte Schilddrüsenkarzinom p-T2/T3 — Ausmaß der Lymphadenektomie

Differentiated Thyroid Carcinoma p-T2/T3 — Extent of Lymphadenectomy

  • Conference paper
Vielfalt und Einheit der Chirurgie Humanität und Wissenschaft

Part of the book series: Langenbecks Archiv für Chirurgie ((KONGRESSBAND,volume 1998))

Summary

Systematic lymphadenectomy, which is compartment-orientated, from central node dissection to (modified) radical neck dissection, is not controversial in cases with intra-operative macroscopic node involvement. General “prophylactic” dissection, at least of the ipsilateral central compartment, is advocated due to a high incidence of “occult”, microscopic positive nodes, and the elevated risk regarding recurrency and survival which is connected to node-positivity, and lowered recurrence rates with systematic lymphadenectomy. Nevertheless, the biological impact of occult positive nodes, as an independent risk-factor, is not yet clear, with important differences between papillary and follicular carcinoma (“marker” or “governor” of the disease?). Enhanced operative morbidity by extensive lymphadenectomy, especially hypoparathyroidism, must be taken into account.

Zusammenfassung

Die Notwendigkeit einer systematischen, kompartmentorientierten Lymphadenektomie ist bei makroskopisch erkennbarem Lymphknotenbefall unumstritten. Sie umfaßt das befallene zentrale Kompartment und die jeweiligen Nachbarkompartments. Die Empfehlung zur grundsätzlichen „prophylaktischen“ Dissektion des zentralen Kompartments in allen Fällen stützt sich auf die Häufigkeit „okkulter“ Lymphknotenmetastasen, das erhöhte Risiko eines positiven N-Status im Hinblick auf Rezidiv und Überleben und die Senkung des Rezidivrisikos durch systematische Lymphadenektomie. Dabei ist die biologische Bedeutung der okkulten Lymphknotenmetastasierung als unabhängiger Risikofaktor noch nicht eindeutig geklärt, mit unterschiedlicher Gewichtung beim papillären und beim follikulären Karzinom. Eine durch die Lymphadenektomie erhöhte Morbidität, insbesondere hinsichtlich des postoperativen Hypoparathyreoidismus, muß berücksichtigt werden.

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Authors and Affiliations

  1. Bürgerhospital Frankfurt, Nibelungenallee 37-41, D-60318, Frankfurt a. M., Deutschland

    R. A. Wahl, I. Rimpl, A. Luther & J. Schabram

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  1. Deutschen Gesellschaft für Chirurgie, Steinhölzle 16, D-89197, Westerstetten-Vorderdenkental, Deutschland

    W. Hartel (Generalsekretär) (Generalsekretär)

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Wahl, R.A., Rimpl, I., Luther, A., Schabram, J. (1998). Das differenzierte Schilddrüsenkarzinom p-T2/T3 — Ausmaß der Lymphadenektomie. In: Hartel, W. (eds) Vielfalt und Einheit der Chirurgie Humanität und Wissenschaft. Langenbecks Archiv für Chirurgie, vol 1998. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-45774-6_43

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  • DOI: https://doi.org/10.1007/978-3-642-45774-6_43

  • Publisher Name: Springer, Berlin, Heidelberg

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