Zusammenfassung
Die chirurgische Therapie kleiner postoperativ diagnostizierter sporadischer C-Zell-Karzinome
der Schilddrüse wird kontrovers diskutiert. Grundsätzlich stehen Komplettierungsoperation
und konsequentes Tumor-Follow-Up zur Debatte. Von 1986 bis 2004 wurden insgesamt 277
Patienten mit einem C-Zell-Karzinom behandelt. Bei 22 Patienten wurde erst postoperativ
die Diagnose eines kleinen (pT1 oder pT2) sporadischen C-Zell-Karzinoms gestellt.
Üblicherweise ist die chirurgische Standardtherapie eines bekannten C-Zell-Karzinoms
eine Thyreoidektomie mit Neck Dissektion. Da es sich bei den 22 Patienten um eine
postoperative Zufallsdiagnose handelte und der Eingriff aus benigner Indikation durchgeführt
wurde, ist bei keinem der Patienten primär eine Thyreoidektomie oder eine Neck Dissektion
durchgeführt worden. Kein Patient wies eine Mutation im RET Proto-Onkogen auf. Die
Familienanamnese war unauffällig. Die Patienten werden systematisch nach definierten
Zeitintervallen mittels Kalzitoninspiegel, Pentagastrinstimulationstest, Karzino-embryonalem
Antigen (CEA) und Ultraschall nachuntersucht. Der mediane Follow-Up liegt bei 6,2
Jahren (Spanne: 2-13 Jahre) und zeigt eine Heilung aller 22 Patienten, obwohl nur
eine Hemithyreoidektomie oder weniger durchgeführt wurde. Wir halten eine Komplettierungsoperation
mit Restthyreoidektomie und Neck Dissektion solcher Patienten für verzichtbar. Voraussetzung
ist eine R0-Resektion sowie der Ausschluss einer RET-Mutation. Unverzichtbar bleibt
eine systematische definierte Tumornachsorge für mindestens 10 Jahre, wenn nicht sogar
lebenslang.
Abstract
Surgical therapy of incidentally postoperative diagnosed small sporadic medullary
thyroid cancer (MTC) is discussed controversially. In principle completion thyroidectomy
with neck dissection and regulary tumor follow-up are under discussion. A total of
277 patients with MTC were treated between 1986 and 2004. In 22 cases diagnosis of
a small (pT1 or pT2) sporadic MTC was incidental and only postoperatively confirmed.
Normally total thyroidectomy with neck dissection is standard surgical therapy of
a known MTC. Because of postoperative incidental diagnosis in all 22 cases surgical
therapy was less then total thyroidectomy. Mutation analysis of RET Proto-Oncogen
and familial history were negative in all cases. All patients were systematically
followed-up in defined intervalls by calcitonin, pentagastrin stimulationtest, carcinoembryonic
antigen and ultrasound. Median follow-up is 6.2 years (range: 2-13 years) and although
a hemithyroidectomy or less was performed all 22 patients are cured by the MTC. We
conclude that completion thyroidectomy and neck dissection are not mandatory in such
patients, if the tumor is completely resected and genetic background is excluded.
Indispensably a systematic long term follow-up of at least 10 years, better a life-long,
is mandatory.
Schlüsselwörter
C-Zell-Karzinom - sporadischer Tumor - Zufallsdiagnose
Key words
c-cell-carcinoma - sporadic tumour - incidental diagnosis
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Dr. med. A. Raffel
Klinik für Allgemein und Viszeralchirurgie · Heinrich-Heine-Universität · Universitätsklinikum
Düsseldorf
Moorenstr. 5
40225 Düsseldorf
Phone: 02 11/8 11 73 50
Email: raffel@med.uni-duesseldorf.de
