Skip to main content
SpringerLink
Log in

Wiederholungseingriffe beim Schilddrüsenkarzinom

Reoperation for thyroid cancer

  • Leitthema
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Die Indikationsstellung zu einem Reeingriff beim Schilddrüsenkarzinom muss patienten-, tumor- und therapiebezogene Aspekte sowie die aktuellen Ergebnisse der Diagnostik berücksichtigen. Es wird zwischen Komplettierungseingriffen (Schilddrüse, Primärtumor, Lymphknoten) und Rezidivoperationen (Tumorbett, Lymphknoten) unterschieden. Die primäre chirurgische Therapiestrategie sollte die Notwendigkeit von Reeingriffen minimieren. Das Ausmaß der Reoperation richtet sich nach dem Umfang der Voroperation und dem Tumorstadium und bezieht ggf. auch Fernmetastasen ein. Im Rahmen einer interdisziplinären multimodalen Therapie des differenzierten Schilddrüsenkarzinoms sind Zeitpunkt und Indikationsstellung der Reoperation von den Rahmenbedingungen der Radioioddiagnostik und Radioiodtherapie abhängig. Das vorrangige Therapieziel eines langfristigen rezidivfreien Überlebens wird durch ein adäquates Radikalitätsausmaß mit akzeptabler Morbidität unter Ausschöpfung aller ergänzender Therapiemodalitäten erreicht.

Abstract

Reoperation for thyroid cancer needs to consider patient-, tumor- and therapy-related aspects as well as present diagnostic results. Reoperation because of thyroid remnants, persistence of the primary tumor and lymph node metastasis (completion surgery) has to be distinguished from reoperation due to locoregional recurrence (primary tumor, lymph nodes). The primary surgical strategy should avoid the need for reoperation. The extent of reoperation is related to the extent of primary surgery, stage, and distant metastasis. The timing and indication of reoperation for differentiated thyroid carcinoma in an interdisciplinary multimodal treatment setting depends on diagnostic radioiodine scans and radioiodine therapy. Long-term, recurrence-free survival is achieved by sufficiently radical surgery with acceptable morbidity, including all additive or adjuvant treatment options.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4

Literatur

  1. American College of Endocrinology (2001) AACE/AAES medical/surgical guidelines for clinical practice: management of thyroid carcinoma. American Association of Clinical Endocrinologists. Endocr Pract 7:202–220

    Google Scholar 

  2. Deutsche Krebsgesellschaft und Deutschen Gesellschaft für Chirurgie (2002) Maligne Schilddrüsentumoren. Interdisziplinäre Leitlinie der Deutschen Krebsgesellschaft und der Deutschen Gesellschaft für Chirurgie. 3. Auf. Dtsch Krebsges

  3. Dralle H, Gimm O (1996) Lymph node excision in thyroid carcinoma. Chirurg 67:788–806

    CAS  PubMed  Google Scholar 

  4. Gimm O, Dralle H (1997) Reoperation in metastasizing medullary thyroid carcinoma: is a tumor stage-oriented approach justified? Surgery 122:1124–1130

    CAS  PubMed  Google Scholar 

  5. Gimm O, Ukkat J, Dralle H (1998) Determinative factors of biochemical cure after primary and reoperative surgery for sporadic medullary thyroid carcinoma. World J Surg 22:562–567

    CAS  PubMed  Google Scholar 

  6. Goretzki PE, Simon D, Frilling A, Witte J, Reiners C, Grussendorf M, Horster FA, Roher HD (1993) Surgical reintervention for differentiated thyroid cancer. Br J Surg 80:1009–1012

    Google Scholar 

  7. Grebe SK, Hay ID (1996) Thyroid cancer nodal metastases: biologic significance and therapeutic considerations. Surg Oncol Clin N Am 5:43–63

    Google Scholar 

  8. Hay ID (1990) Papillary thyroid carcinoma. Endocrinol Metab Clin North Am 19:545–576

    Google Scholar 

  9. Hay ID, Grant CS, van Heerden JA, Goellner JR, Ebersold JR, Bergstralh EJ (1992) Papillary thyroid microcarcinoma: a study of 535 cases observed in a 50-year period. Surgery 112:1139–1146

    CAS  PubMed  Google Scholar 

  10. Hermanek P, Hutter RVP, Sobin LH, Wagner G, Wittekind Ch (1998) TNM-Atlas. Springer, Berlin Heidelberg New York

  11. Hoffman EJ, Tornai MP, Janecek M, Patt BE, Iwanczyk JS (1999) Intraoperative probes and imaging probes. Eur J Nucl Med 26:913–935

    Google Scholar 

  12. Kebebew E, Kikuchi S, Duh QY, Clark OH (2000) Long-term results of reoperation and localizing studies in patients with persistent or recurrent medullary thyroid cancer. Arch Surg 135:895–901

    Google Scholar 

  13. Kim JH, Leeper RD (1987) Treatment of locally advanced thyroid carcinoma with combination doxorubicin and radiation therapy. Cancer 60:2372–2375

    Google Scholar 

  14. Lippi F, Capezzone M, Miccoli P et al. (2000) Use of surgical gamma probe for the detection of lymph node metastases in differentiated thyroid cancer. Tumori 86:367–369

    Google Scholar 

  15. Lopez-Penabad L, Chiu AC, Hoff AO, Schultz P, Gaztambide S, Ordonez NG, Sherman SI (2003) Prognostic factors in patients with Hurthle cell neoplasms of the thyroid. Cancer 97:1186–1194

    Article  PubMed  Google Scholar 

  16. Machens A, Hinze R, Thomusch O, Dralle H (2002) Pattern of nodal metastasis for primary and reoperative thyroid cancer. World J Surg 26:22–28

    PubMed  Google Scholar 

  17. Machens A, Holzhausen HJ, Dralle H (2004) Prediction of mediastinal lymph node metastasis in medullary thyroid carcinoma. Br J Surg 91:709–712

    Google Scholar 

  18. Mazzaferri EL, Jhiang SM (1994) Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med 97:418–428

    CAS  PubMed  Google Scholar 

  19. Negele T, Meisetschläger G, Brückner T, Scheidhauer K, Schwaiger M, Vogelsang H (2005) Radio-guided surgery (RGS) for persistent papillary thyroid cancer: case presentations and possible indications (submitted)

  20. Pasieka JL, Thompson NW, McLeod MK, Burney RE, Macha M (1992) The incidence of bilateral well-differentiated thyroid cancer found at completion thyroidectomy. World J Surg 16:711–716

    Google Scholar 

  21. Proye C (2003) Medullary thyroid carcinomas: persistent hypercalcitoninemia after surgery, reoperations-results. Ann Chir 128:289–292

    Google Scholar 

  22. Rios ZA, Rodriguez Gonzalez JM, Sola PJ, Soria CT, Galindo Fernandez PJ, Parrilla PP (2004) Utility of frozen-section examination for diagnosis of malignancy associated with multinodular goiter. Thyroid 14:600–604

    Google Scholar 

  23. Roeher HD, Simon D, Witte J, Goretzki PE (1993) Principals of limited or radical surgery for differentiated thyroid cancer. Thyroidology 5:93–96

    Google Scholar 

  24. Samaan NA, Schultz PN, Hickey RC, Goepfert H, Haynie TP, Johnston DA, Ordonez NG (1992) The results of various modalities of treatment of well differentiated thyroid carcinomas: a retrospective review of 1599 patients. J Clin Endocrinol Metab 75:714–720

    Google Scholar 

  25. Scheumann GF, Gimm O, Wegener G, Hundeshagen H, Dralle H (1994) Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg 18:559–567

    CAS  PubMed  Google Scholar 

  26. Scheumann GF, Seeliger H, Musholt TJ, Gimm O, Wegener G, Dralle H, Hundeshagen H, Pichlmayr R (1996) Completion thyroidectomy in 131 patients with differentiated thyroid carcinoma. Eur J Surg 162:677–684

    Google Scholar 

  27. Schlumberger M, Tubiana M, De Vathaire F et al. (1986) Long-term results of treatment of 283 patients with lung and bone metastases from differentiated thyroid carcinoma. J Clin Endocrinol Metab 63:960–907

    Google Scholar 

  28. Sherman SI (2003) Thyroid carcinoma. Lancet 361:501–511

    Article  Google Scholar 

  29. Simon D, Goretzki PE, Witte J, Roher HD (1996) Incidence of regional recurrence guiding radicality in differentiated thyroid carcinoma. World J Surg 20:860–866

    Google Scholar 

  30. Stojadinovic A, Ghossein RA, Hoos A et al. (2001) Hurthle cell carcinoma: a critical histopathologic appraisal. J Clin Oncol 19:2616–2625

    Google Scholar 

  31. Tennvall J, Lundell G, Hallquist A, Wahlberg P, Wallin G, Tibblin S (1994) Combined doxorubicin, hyperfractionated radiotherapy, and surgery in anaplastic thyroid carcinoma. Report on two protocols. The Swedish Anaplastic Thyroid Cancer Group. Cancer 74:1348–1354

    Google Scholar 

  32. Timmermann W, Hamelmann WH, Thomusch O et al. (2004) Effectiveness and results of intraoperative neuromonitoring in thyroid surgery. Statement of the Interdisciplinary Study Group on Intraoperative Neuromonitoring of Thyroid Surgery. Chirurg 75:916–922

    Google Scholar 

  33. Travagli JP, Cailleux AF, Ricard M, Baudin E, Caillou B, Parmentier C, Schlumberger M (1998) Combination of radioiodine (131I) and probe-guided surgery for persistent or recurrent thyroid carcinoma. J Clin Endocrinol Metab 83:2675–2680

    Google Scholar 

  34. Vini L, Harmer C (2002) Management of thyroid cancer. Lancet Oncol 3:407–414

    Google Scholar 

  35. Walgenbach S, Junginger T (2002) Is the timing of completion thyroidectomy for differentiated thyroid carcinoma prognostic significant? Zentralbl Chir 127:435–438

    Google Scholar 

  36. Watkinson JC (2004) The British Thyroid Association guidelines for the management of thyroid cancer in adults. Nucl Med Commun 25:897–900

    Google Scholar 

  37. Widder S, Pasieka JL (2004) Primary thyroid lymphomas. Curr Treat Options Oncol 5:307–313

    Google Scholar 

  38. Wittekind Ch, Meyer HJ, Bootz F (2002) TNM Klassifikation maligner Tumoren. Springer, Berlin Heidelberg New York

  39. Zervos EE, Desai DC, DePalatis LR, Soble D, Martin EW (2001) 18F-labeled fluorodeoxyglucose positron emission tomography-guided surgery for recurrent colorectal cancer: a feasibility study. J Surg Res 97:9–13

    Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

  1. Chirurgische Klinik und Poliklinik, Technische Universität München

    H. Vogelsang, T. Brückner & J. R. Siewert

  2. Nuklearmedizinische Klinik, Technische Universität München

    K. Scheidhauer & M. Schwaiger

  3. Schilddrüsenzentrum am Klinikum rechts der Isar, Technische Universität München

    H. Vogelsang & K. Scheidhauer

  4. Chirurgische Klinik und Poliklinik, Technische Universität München, Klinikum rechts der Isar, Ismaninger Straße 22, 81675 , München

    H. Vogelsang

Authors
  1. H. Vogelsang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T. Brückner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Scheidhauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Schwaiger
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. R. Siewert
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Vogelsang.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vogelsang, H., Brückner, T., Scheidhauer, K. et al. Wiederholungseingriffe beim Schilddrüsenkarzinom. Chirurg 76, 238–249 (2005). https://doi.org/10.1007/s00104-005-1006-1

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-005-1006-1

Schlüsselwörter

Keywords

Search

Navigation