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Tumortyp- und tumorstadienorientiertes chirurgisches Konzept bei Karzinomen der Schilddrüse

Tumor type and stage-oriented surgical concept for thyroid carcinoma

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Zusammenfassung

Die chirurgische Therapie der Schilddrüsenkarzinome hat in den letzten Jahren aufgrund verfeinerter Techniken und Nachsorgekonzepte weltweit erhöhte Aufmerksamkeit gefunden. Wegen der tumorbiologischen Besonderheiten der 5 Haupttypen der Schilddrüsenkarzinome und der hiermit in Verbindung stehenden unterschiedlichen adjuvanten (Radiojodtherapie) bzw. additiven (Radiojodtherapie, externe Strahlentherapie, Chemotherapie) Therapieverfahren steht der primäre Karzinomtyp im Mittelpunkt der chirurgischen Therapiestratifizierung. Abhängig von der Ausdehnung des Primärtumors (extrathyreoidal vs. intrathyreoidal) und vom lokoregionären Lymphknotenbefall kann ein erhebliches lokoregionäres Rezidivrisiko bestehen. Aufgrund der zwar reduzierten, aber trotz Rezidiv auch im Langzeitverlauf nicht ungünstigen Prognose ist bei Fehlen einer progredienten Fernmetastasierung insbesondere bei differenzierten und medullären Karzinomen grundsätzlich die Indikation zur Rezidivresektion gegeben. Die Diagnostik von Primärtumoren und Rezidiven konnte insbesondere durch Sonographie und PET/CT wesentlich verbessert werden und hat dadurch nicht nur zu einer früheren Diagnosestellung, sondern auch zu einem differenzierten Verständnis der Tumorbiologie beigetragen.

Abstract

In recent years surgical therapy of thyroid carcinoma has received increased attention worldwide due to refined techniques and postoperative concepts. Due to the biological characteristics of the five main types of thyroid carcinoma and the corresponding different adjuvant (radioiodine therapy) and additive (radioiodine therapy, external radiation therapy and chemotherapy) therapeutic procedures, the type of primary carcinoma is the focus of surgical therapy stratification. There can be a substantial locoregional risk of recurrence depending on the spread of the primary tumor (extrathyroidal versus intrathyroidal) and the locoregional lymph node infestation. Due to the reduced but despite recurrence not unfavorable prognosis even in the long-term, the indications for resection of recurrences are given by a lack of progressive distant metastization especially for differentiated and medullary carcinomas. The diagnostics of primary tumors and recurrences have been substantially improved especially by sonography and PET-CT and have led not only to an earlier diagnosis but also to a differentiated understanding of tumor biology.

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  1. Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Halle, Medizinische Fakultät der Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Ernst-Grube-Straße 40, 06120, Halle/Saale, Deutschland

    H. Dralle FRCS, FACS, K. Lorenz, A. Machens, M. Brauckhoff & P. Nguyen Thanh

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  1. H. Dralle FRCS, FACS
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  2. K. Lorenz
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  3. A. Machens
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  4. M. Brauckhoff
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Correspondence to H. Dralle FRCS, FACS.

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Dralle, H., Lorenz, K., Machens, A. et al. Tumortyp- und tumorstadienorientiertes chirurgisches Konzept bei Karzinomen der Schilddrüse. Onkologe 16, 666–677 (2010). https://doi.org/10.1007/s00761-010-1868-9

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