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01.01.2005 | Leitthema

Chirurgie der Schilddrüsenkarzinome

Sollten nach Einführung der neuen TNM-Klassifikation die chirurgischen Leitlinien geändert werden?

verfasst von: Prof. Dr. H. Dralle, A. Machens, M. Brauckhoff, J. Ukkat, C. Sekulla, P. Nguyen-Thanh, K. Lorenz, O. Gimm

Erschienen in: Die Onkologie | Ausgabe 1/2005

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Zusammenfassung

Durch Änderung der TNM-Klassifikation (2002) hat sich erneut eine intensive Diskussion über die Leitlinien der Chirurgie der Schilddrüsenkarzinome (2000), v. a. in Bezug auf die Frühformen des differenzierten Karzinoms (DTC) entwickelt. Da keine ausreichenden Literaturdaten vorliegen, die eine Definitionsänderung der bisherigen Hauptkategorien der TNM-Klassifikation begründen könnten, die TNM-Klassifikationen von 2002 und 1997 nicht kompatibel sind und die fortgeschrittenen Tumoren (pT3/4) nur in Verbindung mit dem klinischen Befund definiert werden können, stellt die neue TNM-Klassifikation keine geeignete Grundlage zur Stadieneinteilung der Schilddrüsenkarzinome dar. Unabhängig von der neuen TNM-Klassifikation ergibt sich Änderungsbedarf bei den chirurgischen Leitlinien besonders bezüglich der prophylaktischen zentralen Lymphadenektomie beim DTC, für die sich aufgrund vorliegender Daten keine Evidenz nachweisen lässt. Beim hereditären medullären Karzinom ist bei Genträgern ohne klinisch manifesten Tumor wegen der Genotyp-Phänotyp-Korrelation ein risikoadaptiertes Vorgehen hinsichtlich Zeitpunkt und Ausmaß der prophylaktischen Operation zu empfehlen. Bei resektablen, wenig differenzierten und undifferenzierten Karzinomen nimmt die Chirurgie innerhalb eines multimodalen Therapiekonzepts eine wichtige Stellung ein.
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Metadaten
Titel
Chirurgie der Schilddrüsenkarzinome
Sollten nach Einführung der neuen TNM-Klassifikation die chirurgischen Leitlinien geändert werden?
verfasst von
Prof. Dr. H. Dralle
A. Machens
M. Brauckhoff
J. Ukkat
C. Sekulla
P. Nguyen-Thanh
K. Lorenz
O. Gimm
Publikationsdatum
01.01.2005
Verlag
Springer-Verlag
Erschienen in
Die Onkologie / Ausgabe 1/2005
Print ISSN: 2731-7226
Elektronische ISSN: 2731-7234
DOI
https://doi.org/10.1007/s00761-004-0809-x

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