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Organüberschreitende Schilddrüsenkarzinome

Ergebnisse nach trachealem Shaving und Trachearesektion

Extrathyroidal thyroid cancer

Results of tracheal shaving and tracheal resection

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Zusammenfassung

Die laryngotracheale Invasion durch extrathyreoideale Schilddrüsenkarzinome (UICC-Stadium pT4a) repräsentiert einen von außen in die Organwand gerichteten Infiltrationsprozess, der Ausdruck einer hohen neoplastischen Proliferationstendenz ist. Während bei intraluminaler Invasion komplette Tumorentfernungen nur durch lumeneröffnende Vollwandresektionen (Fensterung, zirkuläre Resektion) möglich sind, besteht bei nichttransmuraler Invasion auch die Möglichkeit der nichtlumeneröffnenden tangentialen Resektion („shaving“), was jedoch mit einer erhöhten Rate an mikroskopisch unvollständiger Tumorentfernung (R1-Resektionsrate >40%) assoziiert ist. Bisher wurden zum Vergleich beider Verfahren ausschließlich retrospektive Analysen (EBM-Level max. Grad 3) durchgeführt, deren Ergebnisse zum onkologischen Verlauf widersprüchlich sind. In neueren Untersuchungen wurden für differenzierte Schilddrüsenkarzinome sowohl bezüglich der Lokalrezidivrate als auch des Überlebens Vorteile für die Vollwandresektion gegenüber dem Shaving nachgewiesen. Tiefe Larynxinfiltrationen haben eine schlechtere Prognose als Tracheainfiltrationen, sodass für zervikale Eviszerationen eine entsprechend kritische Patientenselektion erforderlich ist.

Abstract

Extrathyroidal thyroid cancer invading the laryngotracheal system (UICC stage pT4a) represents a progressive process of infiltration of the tracheal wall layers from the outer to the inner parts of the trachea. These tumors usually present with high proliferation activity correlating with a reduced long-term prognosis. In contrast to intraluminal manifestation requiring complete wall resection, in cases of non-transmural invasion, complete tumor removal can be sometimes achieved by extraluminal tangential resection (shaving). Tangential resections, however, are associated with a higher frequency of microscopically invaded resection margins (R1 resection rate >40%). The available comparative studies (all retrospective, maximum EBM level 3) analyzing oncological outcome show inconsistent results. In more recently published studies, however, complete wall resection in well-differentiated thyroid cancer with tracheal invasion only was found to be associated with longer recurrence-free and tumor-specific survival when compared to shaving. Deep larynx invasion is associated with reduced long-term prognosis when compared to invasion of the trachea. Salvage resections should therefore be performed in selected cases only.

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  1. Department of Surgical Sciences, University of Bergen, Bergen, Norway

    M. Brauckhoff

  2. Department of Surgery, Haukeland University Hospital, University of Bergen, Jonas Lies vei 65, 5021, Bergen, Norway

    M. Brauckhoff

  3. Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Halle, Halle, Deutschland

    H. Dralle

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Brauckhoff, M., Dralle, H. Organüberschreitende Schilddrüsenkarzinome. Chirurg 82, 134–140 (2011). https://doi.org/10.1007/s00104-010-1975-6

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