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Lymphadenektomie beim Schilddrüsen- und Nebenschilddrüsenkarzinom

Lymphadenectomy for thyroid and lymph node carcinomas

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Zusammenfassung

Generell wird beim Schilddrüsenkarzinom neben der totalen Thyreoidektomie initial eine zervikozentrale Lymphadenektomie empfohlen. Ausnahmen hiervon sind papilläre Mikrokarzinome sowie so genannte prophylaktische Operationen aufgrund des Vorliegens einer multiplen endokrinen Neoplasie Typ 2A. Über das zervikozentrale Kompartiment hinaus ist eine kompartimentorientierte Lymphadenektomie stets dann indiziert, wenn Lymphknotenmetastasen nachweisbar sind. Da das klinisch nachgewiesene medulläre Schilddrüsenkarzinom oft beidseits zervikolateral metastasiert, ist bei diesen Patienten stets auch ohne präoperativen Metastasennachweis eine bilaterale zervikolaterale Lymphadenektomie indiziert.

Beim Nebenschilddrüsenkarzinom sollte die ipsilaterale zervikozentrale Lymphadenektomie stets en bloc mit der Parathyreoidektomie und Hemithyreoidektomie durchgeführt werden.

Die Lymphadenektomie eines jeden Kompartiments sollte generell systematisch durchgeführt werden, weil sich Lymphknotenmetastasen aufgrund ihrer geringen Größe oft erst histologisch nachweisen lassen.

Abstract

In general, primary surgery of thyroid carcinoma should consist of total thyroidectomy and lymph node dissection of the cervicocentral compartment. Exceptions are cases of papillary microcarcinoma and prophylactic surgery due to multiple type 2A endocrine neoplasia. Lymph node dissection beyond the cervicocentral compartment also should be compartment-oriented. It is generally indicated if lymph node metastases have been proven. Concerning clinically proven medullary thyroid carcinoma, bilateral cervicolateral lymph node dissection is generally indicated, since lymph node metastases may be missed preoperatively but are often found histologically. In patients with parathyroid carcinoma, en bloc ipsilateral cervicocentral lymph node dissection should be performed in addition to parathyroidectomy and hemithyroidectomy. Lymph node dissection should always be performed systematically, since lymph node metastases may be missed both clinically and by imaging techniques.

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  1. Universitäts- und Poliklinik für Allgemein-, Viszeral- und Gefäßchirurgie, Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Straße 40, 06097 , Halle/Saale, Deutschland

    O. Gimm &  H. Dralle

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  1. O. Gimm
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  2. H. Dralle
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Correspondence to H. Dralle.

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Gimm, O., Dralle, H. Lymphadenektomie beim Schilddrüsen- und Nebenschilddrüsenkarzinom. Chirurg 78, 182–193 (2007). https://doi.org/10.1007/s00104-007-1303-y

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