1 / 18

Management of the Locoregional Recurrence in Well-differentiated Thyroid Carcinoma

Management of the Locoregional Recurrence in Well-differentiated Thyroid Carcinoma. 陳漢文. Bias #1. Lymph node is not a prognostic factor in well-differentiated thyroid carcinoma, so prophylactic lymphadenectomy is not indicated. Bias #2. Routine systemic node dissection which

polly
Download Presentation

Management of the Locoregional Recurrence in Well-differentiated Thyroid Carcinoma

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Management of the Locoregional Recurrence in Well-differentiated Thyroid Carcinoma 陳漢文

  2. Bias #1 Lymph node is not a prognostic factor in well-differentiated thyroid carcinoma, so prophylactic lymphadenectomy is not indicated

  3. Bias #2 Routine systemic node dissection which included central neck, lateral neck, even radical neck dissection showed that nodal metastasis near 80% in well-differential thyroid carcinoma. Clinically significant Nodes is around 25% only. Is locoregional recurrence is unavoidable?

  4. Recurrence in WDTC • Low risk group :10-30% recurrent rate • High risk group :20-50% recurrent rate • Overall disease mortality : 30-50% • Shorter disease-free interval

  5. Classification of the Recurrence • Local recurrence (thyroid bed, 28%) • Regional recurrence (neck nodes, 53%) • Locoregional recurrence (both, 6%) • Distal metastasis (others, 13%) Coburn, 1994, Ann Surgery

  6. How to detect locoregional recurrence in thyroid carcinoma? • Clinically detected • Radioiodine scan detected • TSH-stimulated thyroglobulin level • PET Stulak, Arch Surg 2006

  7. Central Neck Recurrence • Residual tumor in thyroid bed • Invasion to trachea, esophageal, laryngx, vessels, etc., • pretracheal nodes, mediastinal nodes, paratracheal nodes (79.7%)

  8. Lateral Neck Recurrence • Level III, IV, V, (23.1%) • Level II III IV V (23.8%) • Berry picking (36.9%) • Selective dissection (16.2%) • Central neck exploration is benefit • Sono-guided dissection is benefit Roh, Head & Neck 2007

  9. Surgical considerations in the recurrent thyroid carcinoma ( I ) • The extent of reoperation is related to the extent of primary surgery, stage, and distant metastasis • Completion total thyroidectomy and central and therapeutic lateral neck dissection for the thyroid remnant, residual tumor, palpated lateral neck nodes • Anterior approach or lateral approach • Long incision or separated incision will be needed

  10. Surgical considerations in the recurrent thyroid carcinoma ( II ) • Laryngoscopy exam should be finished, or recurrent laryngeal nerve resection needed due to invasion • Two stage surgery with 6 weeks interval for the bilateral jugular veins resection • Complication included hypoparathyroidism, recurrent laryngeal nerve injury, thoracic duct injury, Horner syndrome and etc., Vogelsang, Chirurg 2005 Duren, Current treatment options in oncology 2000

  11. Surgical Safety • Experienced surgeon • Neuromonitoring system • Sono-guided or radio-guided surgery Schuff, Laryngoscope 2008 Kim, Arch Otolaryngol Head Neck Surg 2004 Stulak, Arch Surg 2006 Farrag, Head & Neck 2007

  12. Postoperative Radioactive iodine Ablation (ATA guideline) • Stage III and IV disease • Stage II in patients older than 45 yrs • Stage I disease with multifoci, nodal metastases, extrathyroidal extension, vascular invasion or more aggressive histology Cooper, Thyroid 2006

  13. Postoperative radioiodine ablation • Therapeutic ablation -- locoregional -- distant metastases • Prophylactic ablation (<1.5cm)

  14. External radiation • Incomplete surgical resection due to invasion into vital structures • Tumor at the margins of resection in a high surgical risk patient • Metastases in support bones after surgical debulking when possible

  15. Distal metastasis • Surgical removal of discrete local or distant metastases to lung and bone when it can be done safety • Therapeutic radioactive ablation • External radiation

  16. Take Home Message • Total or near-total thyroidectomy is the standard procedure in WDTC • Routine central neck dissection is needed • Remove all palpated nodes in lateral neck compartment • Remove non-palpated nodes which was detected by preoperative sonogram • Postoperative ablation for the selective cases

  17. Take Home Message • Surgery is still the primary management of the recurrent thyroid carcinoma • Careful preoperative workup is very important • Lower morbidity in experienced surgeon’s hands is achieved • Understanding the map of nodal recurrence is the key of the surgical treatment

  18. DISCUSSION

More Related