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Zervikoviszerale Resektionen beim organüberschreitenden Schilddrüsenkarzinom

Cervicovisceral resection in invasive thyroid tumors

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Zusammenfassung

Etwa 6% aller Patienten mit Schilddrϋsenkarzinom weisen eine potenziell vital bedrohliche Tumorinvasion in Trachea und/oder Ösophagus auf. Das Resektionsausmaß richtet sich nach Tumordiagnose und -stadium (Indikation nur bei differenzierten und ggf. medullären Schilddrüsenkarzinomen ohne extrapulmonale Fernmetastasen), aerodigestivem Invasionsausmaß und Allgemeinzustand der Patienten. Mit R0-Resektionen sind 5- bzw. 10-Jahres-Überlebensraten von 40–75% erreichbar. Inkomplette Resektionen verschlechtern die Prognose. Tangentiale Tumorresektionen („shaving“) sind bei nichttransmuraler Tumorinvasion mit guten Langzeitresultaten möglich. Bei den trachealen Resektionsverfahren werden in Abhängigkeit von Tumorlokalisation und -ausdehnung 6 Standardresektionen unterschieden (Typ 1 und 2: Fensterung des laryngotrachealen Winkels bzw. der Trachea; Typ 3 und 4: zirkuläre Resektionen mit Anastomose subglottisch bzw. tracheal; Typ 5 und 6: Laryngektomie bzw. zervikale Eviszeration).

Abstract

About 6% of patients with thyroid cancer present with life-threatening tumor invasion of the trachea and/or esophagus. The extent of resection depends on tumor diagnosis and stage (indication only in differentiated and perhaps medullary thyroid cancer without extrapulmonary metastases), extent of aerodigestive invasion, and general health state of the patient. After complete tumor resection, 5-year and 10-year survival rates of 40–75% can be achieved. Incomplete tumor resection however has a negative effect on prognosis. Tangential tumor resection (shaving) is indicated if no transmural invasion of trachea/esophagus has occurred. Tracheal resection can be subdivided into six standard procedures – types 1 and 2: laryngotracheal or tracheal window resection; types 3 and 4: circular resection with primary reconstruction infraglottic or tracheal; and types 5 and 6: laryngectomy and cervical evisceration.

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  1. Department of Surgery, Haukeland University Hospital, University of Bergen , Jonas Lies vei 65, 5021, Bergen, Norway

    M. Brauckhoff

  2. Klinik für Allgemein Viszeral- und Gefäßchirurgie, Universitätsklinikum Halle, Halle, Deutschland

    H. Dralle

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  2. H. Dralle
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Correspondence to M. Brauckhoff.

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Brauckhoff, M., Dralle, H. Zervikoviszerale Resektionen beim organüberschreitenden Schilddrüsenkarzinom. Chirurg 80, 88–98 (2009). https://doi.org/10.1007/s00104-008-1610-y

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