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Thyroid CA Treatment controversies

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Thyroid CA Treatment controversies

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    1. Thyroid CA Treatment controversies Prof.H. Kayali,MD Head Dpt. of General Surgery Aleppo Medical School

    2. Detailed Thyroid Anatomy

    3. PARATHYROID GLANDS

    4. LARYNGEAL NERVE

    5. THYROID GLAND ANATOMY

    6. Complications; Recurrent laryngeal N, Upper,Lower Parathyroid glandes

    7. Prevalence The prevalence of cancer is higher in several groups: Children Adults less than 30 years or over 60 years old Patients with a history of head and neck radiation Patients with a family history of thyroid cancer Unexplained hoarseness or stridor with a goitre Painless thyroid mass enlarging rapidly over a period of a few weeks Palpable cervical lymphadenopathy Insidious or persistent pain lasting for several weeks

    8. Extent of Surgery (depends on…) Histological types and biological behaviour Risk classification, staging & prognosis Post surgical adjuvant treatment and follow-up Surgical experience

    9. Total thyroidectomy is the surgical management of choice for patients with differentiated thyroid cancer when it can be done safely with a low complication rate & postoperative radioiodine ablation & thyroid-stimulating hormone suppressive therapy

    10. Total thyroidectomy Radioactive iodine may be used to detect and treat residual normal thyroid tissue and local/regional or distant metastases. 2. Serum thyroglobulin level is a more sensitive marker of persistent or recurrent disease when all normal thyroid tissue has been removed

    11. Total thyroidectom 3. In up to 85% of patients with papillary thyroid cancer, microscopic cancer foci are present in the contralateral lobe. By performing total thyroidectomy, these sites are removed as possible sites of recurrence. 4. Recurrence develops in the contralateral lobe in approximately 7% of patients. Up to 50% of patients who develop recurrent cancer will die from thyroid cancer

    12. Total thyroidectomy

    13. Total thyroidectomy 7. Survival is improved for patients with papillary thyroid cancers larger than 1.5 cm and for those with follicular thyroid cancers that are not minimally invasive. 8. The need for reoperative thyroid surgery, which may be associated with an increased risk of complications, is lower.

    14. Analysis of surgical procedures performed in over 1500 US hospitals revealed that among 5584 patients with thyroid cancer, the majority (77.4%) underwent total thyroidectomy regardless of tumor histology and stage

    15. The prognosis of low- risk patients by the age, metastases, extent, size (AMES); age, grade, extent, size (AGES); and primary tumor, regional lymph nodes, distant metastasis (TNM) classifications is excellent in patients who have undergone less than total thyroidectomy

    16. The debate as to whether lobectomy or total thyroidectomy should be performed is centered on the low-risk group Because mortality a recurrence rates are lower in this group, advocates of unilateral thyroid lobectomy

    17. Surgeons who perform total thyroidectomy, however, believe that it is the indicated surgical procedure, chiefly because in low-risk patients with recurrence, 30% to 50% will die from thyroid cancer

    18. In large retrospective series, patients who underwent total or near-total thyroidectomy with postoperative radioactive iodine and TSH suppressive therapy had lower recurrence rates and better survival than those of patients who underwent lesser procedures

    19. multivariate analysis found that patients who underwent completion thyroidectomy within 6 months of their primary operation developed significantly fewer lymph node and hematogenous recurrences and survived significantly longer than those in whom the second operation was delayed for longer than 6 months

    20. Performing lobectomy alone may result in a 5% to 10% recurrence rate in the opposite thyroid lobe , a higher tumor recurrence rate , and a high (11%) incidence of subsequent pulmonary metastases , High recurrence rates in patients with cervical lymph node metastases

    21. In a recent update of Mazzaferri’s patient cohort, surgery and 131I therapy had independent effects on recurrence and cancer mortality . After a median follow-up of 16.6 years, surgery more extensive than lobectomy was an independent variable that reduced the likelihood of cancer death by 50%

    22. Rationale for Total Thyroidectomy (Well differentiated Thyroid Cancer) Bilateral cancers are common (30 – 85%) Recurrent thyroid cancer occurs in 4.7 – 24% (mean recurrence 7% of patients) 50% of patients who develop recurrence die of their disease Eliminates contralateral lobe disease. Central recurrence associated with substantial mortality. Reduces recurrence in all risk group of patient Reduces mortality in patient at high risk.

    23. Thank you

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