[Differentiated thyroid carcinoma. Surgery and significance of lymph node involvement].
BACKGROUND
Nodal treatment in papillary (PTC) and in follicular (FTC) thyroid carcinoma is still a subject of debate.


METHODS
1974-95 therapeutic lymphadenectomy (30/95), 1996-1999 frequent prophylactic lymphadenectomy (32/57; P = 0.005) was used for PTC, with therapeutic lymphadenectomy for FTC (15/115). 131I was used selectively for pN1-tumours.


RESULTS
PTC: The incidence of pN0-, but not of pN1-status increased significantly (P = 0.03). Nodal recurrence was observed in 5/89 (6%) with therapeutic, vs. 1/54 (2%) with prophylactic lymphadenectomy (P = NS), i.e. in 1/107 (0.9%) patients without evidence of nodal disease, vs. 5/36 (14%) of those with pN1-status (P = 0.0004). Survival at 25 yrs. in stages TNM I and II was 100%, i.e., independent of N-status. FTC: No nodal recurrence was observed.


CONCLUSIONS
Occult untreated nodal disease represented no major clinical problem. Selective nodal treatment may offer optimal results; meticulous nodal dissection is indicated for N1-tumours.
Gemsenjäger
E
E
Chirurgische Klinik, Spital Zollikerberg (Neumünster), Zollikerberg/Zürich, Schweiz.
Heitz
P U
PU
Martina
B
B
Schweizer
I
I
D018263:Adenocarcinoma, Follicular / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D013965:Thyroidectomy; D013997:Time Factors
D007457:Iodine Radioisotopes