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Schilddrüsenchirurgie im Alter

Thyroid surgery in the elderly

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Zusammenfassung

Grundlagen: Obwohl das „Alter“ an sich für „große chirurgische Eingriffe“ keine Kontraindikation darstellt, nimmt die Bereitschaft niedergelassener Ärzte Patienten > 75 Jahre dem Chirurgen zu überweisen, mit zunehmendem Patientenalter ab.

Methodik: 55 von 727 Patienten (7.6%; 47 Frauen, 8 Männer), die in den Jahren 1995 bis 1999 an der Schilddrüse operiert wurden, waren 75 Jahre oder älter (Durchschnittsalter: 79,9 ± 4,1 Jahre; median: 78 Jahre). Retrospektiv wurden Operationsindikation, prä-, peri- und postoperativer Verlauf, Morbidität und Mortalität des Schilddrüseneingriffes und postoperativer klinischer Langzeitverlauf analysiert.

Ergebnisse: 30 Patienten (54,5%) wurden wegen hochgradigen Malignitätsverdachts, 25 Patienten (45,5%) wegen sehr großer Knotenstrumen mit entsprechenden mechanischen Beschwerden zur Operation zugewiesen (aufgeschobene Dringlichkeit: 54; Akutoperation: 1; totale Thyreoidektomie: 37; davon mit partieller Sternotomie: n = 3; fast totale Thyreoidektomie: 3; Hemithyreoidektomie: 7; subtotale beidseitige Resektion: 5; Exstirpation eines Lokalrezidivs bei Schilddrüsenkarzinom: 3; gutartige Struma nodosa: 35; maligne Struma: 20 — Anteil anaplastischer Schilddrüsenkarzinome: 33,3%). 45 Patienten (81,8%) hatten eine oder mehrere interne Begleiterkrankungen.

Bei zwei Patienten traten permanente chirurgisch bedingte Komplikationen (einseitige Rekurrensparese: 1; Hypoparathyreoidismus: 1; Morbidität gesamt: 3,6%) auf. Kein Patient ist perioperativ verstorben.

Die mediane Nachbeobachtungszeit beträgt 44 Monate. Die geschätzte 5-Jahresüberlebensrate bei gutartiger Struma lagt bei 65,2 ± 11,6%, bei Struma maligna bei 55,0 ± 12,6%.

Schlußfolgerungen: Schilddrüsenchirurgie kann beim älteren Patienten (≥ 75 Jahre) mit geringer Mortalität und akzeptabler Morbidität durchgeführt werden. Garant für den Erfolg sind eine individuelle Risikoabschätzung und eine sorgfältige präoperative interne Vorbereitung (sehr häufig interne Begleiterkrankungen) gekoppelt mit der Möglichkeit einer intensivmedizinischen postoperativen Überwachung.

Summary

Background: Although „age“ itself is no contraindication for „major surgical procedures“ only few patients ≥ 75 years are sent for surgery by their private physisians.

Methods: 55 out of 727 patients (7.6%; 47 females, 8 males) with thyroid diseases operated on between 1995 and 1999 were 75 years or older (Mean age: 79.9 ± 4.1 years; median: 78 years). The indication for operation, pre-, peri- and postoperative course, morbidity and mortality of surgery and the postoperative clinical course were analysed retrospectively.

Results: Malignancy was suspected in 30 patients (54.5%), 25 patients (45.5%) with symptoms of tracheal and/or esophageal compression were operated on because of large bilateral nodular goitres (delayed emergency: 54; emergency: 1; total thyreoidectomy: 37; with partial sternotomy: n = 3; near total thyreoidectomy: 3; Hemithyreoidectomy: 7; subtotal bilateral resection: 5; Extirpation of a malignant local recurrence: 3; Benign nodular goitre: 35; malignant goitre: 20 — percentage of anaplastic thyroid cancer: 33.3%). 45 patients (81.8%) suffered from one or more additional diseases.

In two patients permanent surgically related complications were documented postoperatively (unilateral paralysis of the recurrent laryngeal nerve: 1; hypoparathyroidism: 1; total morbidity: 3.6%). No patient died postoperatively. The mediane postoperative follow-up period was 44 months. The estimated cumulative 5 years survival of patients with benign histology was 65.2% ± 11.6%, with malignant histology 55.0% ± 12.6%, respectively.

Conclusions: Thyroid surgery in the elderly (≥ 75 years) can be performed with low mortality and acceptable morbidity. The guarantee for the success are an individual risk analysis and a careful preoperative medical preparation (high rate of additional diseases) combined with the possibility of intensive care postoperatively.

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Authors and Affiliations

  1. Extraordinariat für Spezielle Chirurgie — Chirurgische Endokrinologie, Klinische Abteilung für Allgemeinchirurgie, Universitätsklinik für Chirurgie, Währinger Gürtel 18-20, A-1090, Wien

    Ch. Passler, R. Avanessian, K. Kaczirek, G. Prager, Ch. Scheuba, M. Schindl & B. Niederle

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  1. Ch. Passler
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  2. R. Avanessian
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  3. K. Kaczirek
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  5. Ch. Scheuba
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Passler, C., Avanessian, R., Kaczirek, K. et al. Schilddrüsenchirurgie im Alter. Acta Chir. Austriaca 33, 288–292 (2001). https://doi.org/10.1007/BF02948101

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