内容紹介
Surgical Treatment of Thyroid Cancer
Summary
The strategy for surgical treatment of thyroid cancer differs depending on the histopathological type. In papillary thyroid cancer, which accounts for most cases of thyroid cancer, total thyroidectomy is recommended in high-risk cases with tumors of more than 5 cm or with N1, EX2, or M1 tumors in Japan. On the other hand, ipsilateral lobectomy is performed for low-risk cases with T1N0M0. Our department has also added a treatment policy for the prognostic factor, age. Prophylactic lymph node dissection is performed in the central neck region but is not recommended in the lateral neck region.
In follicular thyroid cancer, total thyroidectomy is recommended for widely invasive cancer, and hemithyroidectomy or ipsilateral lobectomy is performed for minimally invasive cancer. When widely invasive cancer is diagnosed after lobectomy, completion thyroidectomy is recommended.
Whether minimally invasive follicular cancer with vascular invasion requires completion thyroidectomy is controversial.
I also handle medullary thyroid cancer, poorly differentiated thyroid cancer, undifferentiated thyroid cancer, and thyroid malignant lymphoma with a different policy. It is important to balance a surgical treatment strategy with a molecular targeted therapy and radioactive iodine treatment.
要旨
甲状腺癌の外科治療戦略は組織型によっても大きく異なる。大半を占める乳頭癌では,本邦においては5 cm以上,N1,EX2,M1などの高リスク群の場合は全摘を,T1N0M0の低リスク群の場合は葉切除を行う。当科ではさらに年齢の予後因子も加えた治療方針を作成している。リンパ節郭清は中央領域は予防的郭清を行うが,外側領域では術前診断がついたもののみ実施する。濾胞癌は微少浸潤型では片葉切除のみ,広範浸潤型では全摘ないし術後補完全摘を選択している。脈管侵襲のある微少浸潤型では補完全摘術を追加するか異論のあるところである。髄様癌,低分化癌,未分化癌,甲状腺悪性リンパ腫についてもそれぞれに異なった方針で対処する。分子標的治療薬や放射性ヨウ素治療との兼ね合いからも外科治療の戦略確立は重要である。
目次
Summary
The strategy for surgical treatment of thyroid cancer differs depending on the histopathological type. In papillary thyroid cancer, which accounts for most cases of thyroid cancer, total thyroidectomy is recommended in high-risk cases with tumors of more than 5 cm or with N1, EX2, or M1 tumors in Japan. On the other hand, ipsilateral lobectomy is performed for low-risk cases with T1N0M0. Our department has also added a treatment policy for the prognostic factor, age. Prophylactic lymph node dissection is performed in the central neck region but is not recommended in the lateral neck region.
In follicular thyroid cancer, total thyroidectomy is recommended for widely invasive cancer, and hemithyroidectomy or ipsilateral lobectomy is performed for minimally invasive cancer. When widely invasive cancer is diagnosed after lobectomy, completion thyroidectomy is recommended.
Whether minimally invasive follicular cancer with vascular invasion requires completion thyroidectomy is controversial.
I also handle medullary thyroid cancer, poorly differentiated thyroid cancer, undifferentiated thyroid cancer, and thyroid malignant lymphoma with a different policy. It is important to balance a surgical treatment strategy with a molecular targeted therapy and radioactive iodine treatment.
要旨
甲状腺癌の外科治療戦略は組織型によっても大きく異なる。大半を占める乳頭癌では,本邦においては5 cm以上,N1,EX2,M1などの高リスク群の場合は全摘を,T1N0M0の低リスク群の場合は葉切除を行う。当科ではさらに年齢の予後因子も加えた治療方針を作成している。リンパ節郭清は中央領域は予防的郭清を行うが,外側領域では術前診断がついたもののみ実施する。濾胞癌は微少浸潤型では片葉切除のみ,広範浸潤型では全摘ないし術後補完全摘を選択している。脈管侵襲のある微少浸潤型では補完全摘術を追加するか異論のあるところである。髄様癌,低分化癌,未分化癌,甲状腺悪性リンパ腫についてもそれぞれに異なった方針で対処する。分子標的治療薬や放射性ヨウ素治療との兼ね合いからも外科治療の戦略確立は重要である。