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Die Chirurgie
Erschienen in: Die Chirurgie 1/2023

19.09.2022 | Radioiodtherapie | Aktuelles Thema

Hemithyreoidektomie oder totale Thyreoidektomie beim papillären Niedrigrisikokarzinom der Schilddrüse?

Chirurgische Kriterien der primären und sekundären Therapiewahl im interdisziplinären Behandlungskonzept

verfasst von: Prof. Dr. med. Dr. h.c. mult. H. Dralle, FRCS FACS FEBS, F. Weber, A. Machens, T. Brandenburg, K. W. Schmid, D. Führer-Sakel

Erschienen in: Die Chirurgie | Ausgabe 1/2023

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Zusammenfassung

Die seit 2 Jahrzehnten weltweit beobachtete Zunahme kleiner intrathyroidaler papillärer Schilddrüsenkarzinome (PTC) bei gleichbleibender Mortalität hat zu einem Überdenken des bisherigen Konzepts der totalen Thyreoidektomie als „One-size-fits-all“-Strategie geführt. Nach systematischer Auswertung der seit 2002 durchgeführten 20 Vergleichsstudien zur Hemithyreoidektomie (HT) vs. totalen Thyreoidektomie (TT) ergibt sich nach Ausschluss papillärer Mikrokarzinome für intrathyreoidal papilläre sog. „Low-risk“(Niedrigrisiko)-Karzinome (LRPTC) mit 1–4 cm Durchmesser ein vergleichbares onkologisches Langzeitoutcome für die HT und die TT bei deutlich niedrigeren postoperativen Komplikationsraten im Falle der HT. Zur individuellen Präzisierung der Therapiestrategie sollte die HT zum Staging mit einer ipsilateral zentralen Lymphknotendissektion mit intraoperativem Gefrierschnitt kombiniert werden. Patienten mit LRPTC kann unter Berücksichtigung individueller Risikofaktoren aufgrund vorliegender Studien das Konzept der HT als Alternative zur bisherigen Standard-TT angeboten werden. Voraussetzung der Therapiewahl und -entscheidung ist eine eingehende Patienteninformation über die möglichen Vor- und Nachteile beider Verfahren.
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Metadaten
Titel
Hemithyreoidektomie oder totale Thyreoidektomie beim papillären Niedrigrisikokarzinom der Schilddrüse?
Chirurgische Kriterien der primären und sekundären Therapiewahl im interdisziplinären Behandlungskonzept
verfasst von
Prof. Dr. med. Dr. h.c. mult. H. Dralle, FRCS FACS FEBS
F. Weber
A. Machens
T. Brandenburg
K. W. Schmid
D. Führer-Sakel
Publikationsdatum
19.09.2022
Verlag
Springer Medizin
Erschienen in
Die Chirurgie / Ausgabe 1/2023
Print ISSN: 2731-6971
Elektronische ISSN: 2731-698X
DOI
https://doi.org/10.1007/s00104-022-01726-4

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