갑상선유두암의 적절한 수술 범위
Optimal Extent of Surgery for Papillary Thyroid Carcinoma
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The goal of thyroid cancer surgery is the complete removal of the cancer, verification that patients receiveappropriate treatment through accurate staging after surgery, minimization of local recurrence, and improvementof survival rate. However, maintaining the patient’s functional outcome and quality of life by minimizingpostoperative complications as well as having good oncological outcomes is also important. To determine theoptimal surgical extent, appropriate diagnosis and evaluation should be made on age, gender, tumor size, multiplicity,extrathyroidal extension, lymph node/distant metastasis, and biologic aggressiveness. In the low-risk group, lobectomyis required, and experienced high-volume surgeons may consider ipsilateral prophylactic central lymph nodedissection because of the acceptable risk of hypoparathyroidism. In the intermediate-risk group, personalizeddecision-making should be determined according to the patient’s preferences and characteristics while alsoconsidering the pros and cons of lobectomy or total thyroidectomy. For the patient with high-risk factors, totalthyroidectomy is considered. However, if a total thyroidectomy is not absolutely necessary and complications areexpected, lobectomy could be a second option. If the patient has central lymph node metastasis, a therapeuticcentral lymph node dissection must be performed, and in the case of high-risk groups (T3/4 and N1b), ipsilateralprophylactic node dissection should be considered, and the contralateral parathyroid gland should be preserved. In the high-risk group (especially with massive ipsilateral lymph node metastasis or gross extrathyroidal involvement),the surgeon may consider bilateral central lymph node dissection if the ipsilateral parathyroid gland and therecurrent laryngeal nerve are well preserved, because of the risk of contralateral lymph node metastasis.
Abstract
The goal of thyroid cancer surgery is the complete removal of the cancer, verification that patients receiveappropriate treatment through accurate staging after surgery, minimization of local recurrence, and improvementof survival rate. However, maintaining the patient’s functional outcome and quality of life by minimizingpostoperative complications as well as having good oncological outcomes is also important. To determine theoptimal surgical extent, appropriate diagnosis and evaluation should be made on age, gender, tumor size, multiplicity,extrathyroidal extension, lymph node/distant metastasis, and biologic aggressiveness. In the low-risk group, lobectomyis required, and experienced high-volume surgeons may consider ipsilateral prophylactic central lymph nodedissection because of the acceptable risk of hypoparathyroidism. In the intermediate-risk group, personalizeddecision-making should be determined according to the patient’s preferences and characteristics while alsoconsidering the pros and cons of lobectomy or total thyroidectomy. For the patient with high-risk factors, totalthyroidectomy is considered. However, if a total thyroidectomy is not absolutely necessary and complications areexpected, lobectomy could be a second option. If the patient has central lymph node metastasis, a therapeuticcentral lymph node dissection must be performed, and in the case of high-risk groups (T3/4 and N1b), ipsilateralprophylactic node dissection should be considered, and the contralateral parathyroid gland should be preserved. In the high-risk group (especially with massive ipsilateral lymph node metastasis or gross extrathyroidal involvement),the surgeon may consider bilateral central lymph node dissection if the ipsilateral parathyroid gland and therecurrent laryngeal nerve are well preserved, because of the risk of contralateral lymph node metastasis.
참고문헌 (27)
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