7. Radikalitätsprinzipien bei der Operation maligner Schilddrüsentumoren

Abstract

Different concepts are required by different tumors: anaplastic carcinomas rarely are accessible to curative surgery, but tumor reduction gives sense in combined concepts. In follicular carcinomas general ("near"-) total thyroidectomy + radioiodine + hormonal suppressive therapy is recommended, with respect to the high incidence of distant metastases even in low 1 degree Tu-stages. Papillary carcinomas allow a stage related procedure with exceptions from total thyroidectomy: no reintervention for "occult" carcinomas and-in patients under 40 years of age-hemithyroidectomy for intrathyroid tumors without regional metastases. In C-Cell-carcinomas total thyroidectomy has to be accompanied by lymph-node dissections of various extent, depending on familiary or sporadic type and tumor-stage.

Anaplastic (undifferentiated) thyroid carcinoma (ATC)

“…Because of the bad results, the use of surgical intervention, but mainly its extent (biopsy, thyroidectomy, restricted radical or ultraradical approach, palliative resection) is being judged in various ways [1,4,14,17,25,26,28,33,35,38,45,46]. Scheumann et al [25] and Hollinsky et al [38] reported of a significantly better prognosis after complete tumor resection.…”

European endocrine surgery in the 150-year history of Langenbeck’s Archives of Surgery

“…11) -Surgical anatomy of the thyroid [93], thyroid surgery in children [94,95], recurrent goiter [96,97], Graves' disease [98][99][100][101][102][103], and thyroid cancer [104][105][106][107][108][109][110][111][112][113][114][115], in particular, differentiated [116][117][118][119][120][121][122][123] and medullary thyroid carcinoma [124][125][126][127][128][129][130] -Parathyroid surgery for primary [131][132][133][134][135][136][137][138][139][140][141]…”

Chirurgie der Metastasen differenzierter Schilddr�sencarcinome

“…Chirurgisch-operative Metastasenentfernungen werden nur selten empfohlen und dies auch nur in F~illen nicht jodspeichernder Metastasen oder nach eingetretenen Komplikationen wie pathologischen Frakturen ohne oder mit neurologischen Ausf/illen [4,13]. Sie verlangen die Prfifung aller verfiigbaren therapeutischen Verfahren und somit auch chirurgischer Behandlungsm6glichkeit [21]. Sie verlangen die Prfifung aller verfiigbaren therapeutischen Verfahren und somit auch chirurgischer Behandlungsm6glichkeit [21].…”