Novosti
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Year 2013 Vol. 21 No 6
ONCOLOGY
E.V. RYABCHENKO
CENTRAL LYMPHADENECTOMY AT THYROID CANCER IN COMBINATION WITH AUTOIMMUNE THYROIDITIS
SBME "Krasnodar Regional Clinical Hospital № 2"
"Interregional Center of the Endocrine Surgery"
The Russian Federation
Objectives. To determine the incidence of metastasis to the central group of the neck lymph nodes in a case of the thyroid cancer in combination with autoimmune thyroiditis (AIT) and find out the need to remove the cellulaz from the affected area.
Methods. The patients were divided into four groups. The first group consisted of the patients in whom metastasis to the regional lymph nodes was excluded based on the ultrasound investigation. Extrafascial thyroidectomy with a prophylactic central lymphadenectomy (CLA) has been performed. The second group included those in whom hemistrumectomy was expanded to a thyroidectomy with a prophylactic CLA after urgent histological investigation verifying cancer during the operation. The third group was made up of the patients with the diagnosed cancer after receiving the final histology data. In these cases a total thyroidectomy with a prophylactic CLA was performed as a second treatment stage. The fourth group was composed of the patients with regional lymph node metastasis of the II-V level (stage pTl-4aNlb) cytologically verified prior the surgery and the extrafascial thyroidectomy in the combination with therapeutic CLA (VI level) and fascial-covering lymphadenectomy (II-V level) have been performed.
Results. Metastasis incidence to the neck regional lymph nodes in a case of well-differentiated thyroid cancer reaches 36,1% at the papillary carcinoma and 12,2% at the follicular carcinoma without dependence on the tumor size. Metastasis incidence to the inner organs makes up 14,4% and 26,8%, correspondently. Modern ultrasound and cytological diagnostic methods don’t allow revealing intra-organ and regional metastasis to the main lymphatic collector – the VI zone of the neck cellulaz tissue at the preoperative period. It requires radical surgical tactics application with an obligatory total removal of the thyroid tissue and the central lymph collector of the neck.
Conclusions. Total thyroidectomy should be considered as the method of choice for surgical treatment of well-differentiated thyroid cancer in the combination with AIT, regardless of size and cytological characteristics of the tumor; it should be combined with the central (bilateral) neck lymphadenectomy.
- Rumiantsev PO, Il'in AA, Rumiantseva UV, Saenko VA. Rak shchitovidnoi zhelezy: Sovremennye podkhody k diagnostike i lecheniiu [Thyroid cancer: the current approaches to diagnosis and treatment]. Moscow, RF: GEOTAR-Media, 2009. 476 p.
- Kennedi L, Basu A, Fadeev VV, red. Per s angl. Diagnostika i lechenie v endokrinologii. Problemnyi podkhod: rukovodstvo [Diagnosis and treatment of endocrinology. Problematic approach: a guide].Moscow, RF: GEOTAR-Media». 2010. 304 p.
- Frederick L Greene, David L Page, Irvin D Fleming, April G. Fritz, C.T.R., R.H.I.T. Charles M Balch, Daniel G Haller, Monica Morrow, Ed. AJCC Cancer Staging Manual. American Joint Committee of Cancer. – 6th ed. Springer, 2002.
- Comparison Guide: Cancer Staging Manual [Electronic resource]. – 6th ed. AJCC, 2002. Mode of access : www.cancerstaging.org.
- Kharnas SS, red, Ippolitov LI, Vasil'ev IA, Vetshev SP; Kharnas, S. S. Endokrinnaia khirurgiia : ruk. dlia vrachei [Endocrine Surgery: a guide for physicians]. Moscow, RF: GEOTAR-Media, 2010. 490 p.
- Adamian RT, Bel'tsevich DG, Butrova SA, Vanushko VE, Gazizova DO. In: Dedov II, Kuznetsov NS, Mel'nichenko GA, red. Endokrinn Khirurgiia [Endocrine Surgery]. Moscow, RF: Litterra, 2011. 352 p.
- Costanzo M, Caruso LA, Testa R, Marziani A, Cannizzaro MA. Hashimoto thyroiditis. Possible cause or consequence of a malignant thyroid tumor. Ann Ital Chir. 2006 Nov-Dec;77(6):469–71.
- Lucioni Marco. Practical Guide to Neck Dissection. Berlin Heidelberg New York: Springer-Verlag, 2007.
- Greene FL, Page DL, Fleming ID, Fritz A, Balch CM, Haller DG, Morrow M, eds. AJCC Cancer Staging Manual, 6th ed. Berlin: Springer-Verlag; 2002. 435 p.
- Deshler DG, Day Т. Pocket guide to neck dissection classification and tnm staging of head and neck cancer. American Academy of Otolaryngology Head & Nee [Electronic resource]. 2008. Available: http://www.cancerstaging.org.
- Thyroid Carcinoma. NCCN Clinical Practice Guidelines in Oncology Thyroid Carcinoma V2.2007. Available: www.nccn.org
350901, Rossiiskaia Federatsiia, g. Krasnodar, ul. Krasnykh Partizan, d. 6/2, GBUZ «Krasnodarskaia kraevaia klinicheskaia bol'nitsa №2», khirurgicheskoe otdelenie №2,
e-mail: rev7512@mail.ru, Ryabchenko Evgenii Viktorovich
Ryabchenko E.V. PhD, a surgeon of the surgical department №2 of "Interregional center of the endocrine surgery" of SBME "Krasnodar Regional Clinical Hospital № 2".
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