Современная онкология (Jun 2016)
Improved technique thyroidectomy with lateral modified radical neck dissection
Abstract
Background. According to World Health Organization thyroid cancer (TC) is the most common endocrine malignancy. The frequency of regional lymph node (LN) lesions in this disease may be up to 80%, which requires advanced operations. In cases when metastasis develop in the II-V group cervical LN, should be perfomed thyroidectomy with functional neck dissection. Life expectancy and life quality of this severe category of patients depends on perfomed intervention. Extent and operation technique tend to move to functionally sparing methods, which aimed to preserve oncological principles with anatomical structures damage prevention and to promote better cosmetic effects. However, existing nowadays interventions do not always combine these requirements. The foregoing calls for further improvement of the operation - thyroidectomy with lateral modified radical neck dissection with the achievement of the maximum radicalism, optimal safety and the desired cosmetic result of intervention. Aim. Improving the results of surgical treatment of patients with TC with metastases in the LN group II-V operation areas by improving methodology, with a decrease in the number of complications and achieving the desired cosmetic effect without prejudice radical intervention. Materials and methods. Study based on results of treatment of 46 patients with different forms of cancer which were examined and operated in department of endocrine surgery of S.P.Botkin City Clinical Hospital of the Department of Health of Moscow. Patients were divided on 2 groups. In first group were included 22 (47.8%) patients operated in the period from 2008 to 2011 and in second group 24 (52.2%) patients who received treatment with 2012 by 2015. Here with cancer forms in first group were distributed as follows: papillary cancer - 18 (81.8%) cases, follicular - 3 (13.6%) and medullary - 1 (4.5%) follow up. In second group papillary cancer has been identified in 18 (75.0%) patients, follicular in 3 (12.5%) and medullary - in 2 (8.3%). Extent of process was assessed and in first group: T1bN1bM0 - in 2 (9.1%) cases, and in second group - in 3 (12.5%) cases, T2N1bM0 - in 7 (31.8%) and 9 (37.5%), a T3N1bM0 - in 13 (59.1%) and 12 (50.0%) surveillances respectively. Age ratio ranged from 35 to 65 years. Mean age in first group was 50 years for men and 52 for women, while in the second group - 45 years for men and 48 years. Sex ratio in both groups - 1:9; 21 (95.5%) and 22 (91.7%) patients with differentiated cancer forms underwent radioiodine therapy. Conclusion. Proposed improved method of thyroidectomy with functional neck dissection using in patients with TC allows to perform a radical operation achieving required safety of intervention and preserve patients life quality.
