Estudio descriptivo de doce años de cáncer de tiroides, Manizales, Colombia
Palabras clave:
neoplasias de la tiroides, carcinoma papilar, tiroidectomíaResumen
Introducción. Dado el aumento en la incidencia de cán- cer de tiroides, es importante conocer nuestra experien- cia y compararla con otros grupos, para así ajustar nuestras guías de manejo buscando optimizar los re- sultados en términos de supervivencia, recurrencia y morbilidad.
Materiales y métodos. Se trata de un estudio observacional descriptivo y retrospectivo, durante un periodo de 12 años, en pacientes atendidos con cán- cer de tiroides por el Grupo de Cirugía de Cabeza y Cuello.
Se evaluaron la distribución de frecuencias absolutas, relativas y las razones y medidas de dispersión y de tendencia central. Para el análisis de supervivencia se uso el método de Kaplan-Meier.
Resultados. Se encontraron 544 pacientes elegibles para el estudio, 84% mujeres y 16% hombres, con una me- dia de edad de 46 años.
La distribución por tipo de cáncer fue: carcinoma papilar (87%), folicular (7,7%), anaplásico (3,5%) y medular (1,3%).
El tratamiento primordial fue tiroidectomía total con vaciamiento. La supervivencia global para los cánce- res diferenciados fue de 92% a 10 años, de 70% a 5 años para el medular y ninguna a 5 años para el anaplásico. La recurrencia en los tumores bien dife- renciados fue de 8%.
La morbilidad por lesión del nervio recurrente fue de 0,9% y el hipoparatirodismo definitivo, de 1,1%
Discusión. Al comparar nuestra experiencia con la de otros grupos, encontramos que la tiroidectomía total y el vaciamiento central o modificado y la resección laríngea o traqueal, según el caso, fue un tratamiento seguro con baja morbilidad lo que permite mantener la curación con buena calidad de vida.
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Referencias bibliográficas
2. Boone RT, Chun YF, Hanna E. Well differentiated carcinoma of the thyroid. Otolaryngol Clin North Am. 2004;36:73-90.
https://doi.org/10.1016/S0030-6665(02)00127-5
3. Cooper D, Doherty G, Haugen B, Klooss R, Lee S. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid. 2006;16:1-33.
https://doi.org/10.1089/thy.2006.16.109
4. Ogawa Y, Kato Y, Ikeda K, Nagai E. The value of ultrasound- guided fine-needle aspiration cytology for thyroid nodules: An assessment of its diagnostic potential and pitfalls. Surg Today. 2001;31:97-101
https://doi.org/10.1007/s005950170190
5. Boyd LA, Earnhardt RC, Dunn JT. Preoperative evaluation and predictive value of fine-needle aspiration and frozen section of thyroid nodules. J Am Coll Surg. 1998;187:494-502.
https://doi.org/10.1016/S1072-7515(98)00221-X
6. Hay I. Papillary thyroid carcinoma. Endocrinol Metab Clin North Am. 1990;19:545-76.
https://doi.org/10.1016/S0889-8529(18)30310-4
7. Stokkel MP, de Klerk JM, Hordijk GJ. Fluorodeoxyglucose positron emission tomography, a new technique for increasing the detection rate of coincident thyroid cancer in head and neck oncology. Eur Arch Otorhinolaryngol. 2000;257:552-4.
https://doi.org/10.1007/s004050000268
8. Kim N, Lavertu P. Evaluation of a thyroid nodule. Otolaryngol Clin North Am. 2003;36:17-33.
https://doi.org/10.1016/S0030-6665(02)00130-5
9. De Jong SA, Demeter JG, Jarosz H. Primary papillary thyroid carcinoma presenting as cervical lymphadenopathy: The operative approach to the ''lateral aberrant thyroid''. Am Surg. 1993;59:172-7.
10. LiVolsi VA. Pathology of the thyroid gland. Second edition. New York: Marcel Dekker, Inc.; 2001. p. 201-37.
11. Dean D, Hay ID. Prognostic Indicators in differentiated thyroid carcinoma. Cancer Control. 2000;7:229-39.
https://doi.org/10.1177/107327480000700302
12. DeGroot LJ, Kaplan EL, Straus FH, Hayes S. Does the method of management of papillary thyroid carcinoma make a difference in outcome? World J Surg. 1994;18:123-30.
https://doi.org/10.1007/BF00348202
13. Duren M, Yavuz N, Bukey Y. Impact of initial surgical treatment on survival of patients with differentiated thyroid cancer: Experience of an endocrine surgery center in an iodine-deficient region. World J Surg. 2000;24:1290.
https://doi.org/10.1007/s002680010214
14. Shaha AR, Shah JP, Loree TR. Patterns of failure in differentiated carcinoma of the thyroid based on risk groups. Head Neck. 1998;20:26-30.
https://doi.org/10.1002/(SICI)1097-0347(199801)20:1<26::AID-HED5>3.0.CO;2-5
15. Chala A. Patología tiroidea y su tratamiento quirúrgico. Rev Colomb Cir. 1997;12:179-85.
16.Hegedus L. The thyroid nodule. N Engl J Med. 2004;351:1764-71.
https://doi.org/10.1056/NEJMcp031436
17. Alsanea O, Clark O. Treatment of Graves disease: The advantages of surgery. Endocrinol Metabol Clin North Am. 2000;29:765-74.
https://doi.org/10.1016/S0889-8529(05)70134-1
18. Lee J, Nam K, Chung W, Soh E, Park Ch. Clinicopathologic features and treatment outcomes in differentiated thyroid carci- noma patients with concurrent Graves disease. J Korean Med Sci. 2008;23:796-801.
https://doi.org/10.3346/jkms.2008.23.5.796
19. Affleck B, Swartz K, Brennan J. Surgical considerations and controversies in thyroid and parathyroid surgery. Otolaryngol Clin North Am. 2003;36:159-87.
https://doi.org/10.1016/S0030-6665(02)00135-4
20. Staunton M, Greening W. Clinical diagnosis of thyroid cancer. Br Med J. 1973;4:b532-5.
https://doi.org/10.1136/bmj.4.5891.532
21. Jo V, Stelow E, Dustin S, Hanley K. Malignancy risk for fine needle aspiration of thyroid lesions according to the Bethesda System for Reporting Thyroid Cytopathology. Am J Clin Pathol. 2010;134:450-6.
https://doi.org/10.1309/AJCP5N4MTHPAFXFB
22. Kim M, Mandel S, Valok Z. Morbidity following central compartment reoperation for recurrent or persistent thyroid cancer. Arch Otolaryngol Head and Neck Surg. 2004;130:1214-6.
https://doi.org/10.1001/archotol.130.10.1214
23. Palme C, Waseem Z, Raza N, Eski S, Walfish P. Management and outcome of recurrent well-differentiated thyroid carcinoma. Arch Otolaryngol Head and Neck Surg. 2004;130:819-24.
https://doi.org/10.1001/archotol.130.7.819
24. Ito Y, Jikuzono T, Higashiyama T. Clinical significance of metastasis to the central compartment from papillary microcarcinoma of the thyroid. World J Surg. 2006;30:91-9.
https://doi.org/10.1007/s00268-005-0113-y
25. Doi SA, Engel JM, Onitilo AA. Cancer-specific survival is significantly improved by total thyroidectomy and by a trend for 131IRRA, but not for disease-free recurrence. Clinical Thyroidology. 2010;22:14-7.
26. So YK, Sun YL, Hong SD, Seo MY, Baek CH. Central neck compartment lymph-node-metastases in papillary thyroid carci- noma can be effectively managed with prophylactic CLND without a high complication rate and with very few recurrences. Clinical Thyroidology. 2010;22:10-3.
27. Wang T, Dubner S, Sznyter L, Heller K. Thyroid cancer in cer- vical lymph nodes. Arch Otolaryngol Head and Neck Surg. 2004;130:110-3.
https://doi.org/10.1001/archotol.130.1.110
28. BilimoriaKY,BentremDJ,KoCY.Extentofsurgeryaffectssurvival for papillary thyroid cancer. Ann Surg. 2007;246:375-84.
https://doi.org/10.1097/SLA.0b013e31814697d9
29. Fritze D, Doherty G. Surgical management of cervical lymph nodes in differentiated thyroid cancer. Otolaryngol Clin North Am. 2010;43:285-300.
https://doi.org/10.1016/j.otc.2010.01.005
30. Al-Saif O, Farrar WB, Bloomston M, Porter K, Ringel MD, Kloos Rt. Persistent cervical PTC lymph-node metastases may require several surgical resections to achieve biochemical or clinical evidence of disease-free outcome. J Clin Endocrinol Metab. 2010;95:2187-94.
https://doi.org/10.1210/jc.2010-0063
31. Pai S, Tufano R. Reoperation for recurrent/persistent well- differentiated thyroid cancer. Otolaryngol Clin North Am. 2010;43:353-63.
https://doi.org/10.1016/j.otc.2010.02.004
32. Kim K, Sung M, Chang K, Kang B, Therapeutic dilemmas in the management of thyroid cancer with laryngotracheal involvement. Otolaryngol Head Neck Surg. 2000;122:763-7.
https://doi.org/10.1016/S0194-5998(00)70212-9
33. Urken M. Prognosis and management of invasive well- differentiated thyroid cancer. Otolaryngol Clin North Am. 2010;43:301-28.
https://doi.org/10.1016/j.otc.2010.02.002
34. Chala A. Abordaje del carcinoma de tiroides invasivo a traqueolaringe y grandes vasos. Rev Colomb Cir. 2002;17:10-21.
35. Shin DH, Mark EJ, Suen HC. Pathologic staging of papillary carcinoma 1940-1990. Head Neck. 1994;16:165-72.
https://doi.org/10.1002/hed.2880160211
36. Fewins J, Simpson B, Miller F. Complications of thryroid and parathyroid surgery. Otolaryngol Clin North Am. 2003;36:189-206.
https://doi.org/10.1016/S0030-6665(02)00129-9
37. Canbaz H, Dirlik M, Colak T, Ocal K, Akca T, Bilgin O, et al. Total thyroidectomy is safer with identification of recurrent laryngeal nerve. J Zhejiang Univ SCi B. 2008;6:482-8.
https://doi.org/10.1631/jzus.B0820033
38. Sanders G, Uyeda RY, Karlan MS. Nonrecurrent inferior laryngeal nerves and their association with a recurrent branch. Am J Surg. 1983;146:456-68.
https://doi.org/10.1016/0002-9610(83)90240-4
39. Sabet A, Kim M. Postoperative management of differentiated thyroid cancer. Otolaryngol Clin N Am. 2010;43:329-51.
https://doi.org/10.1016/j.otc.2010.02.003
40. Reeve T, Thompson NW. Complications of thyroid surgery: How to avoid them, how to manage them, and observation of their possible effect on the whole patient. World J Surg. 2000;24:971-5.
https://doi.org/10.1007/s002680010160
41. Mazzaferri EL. Thyroid remnant 131I ablation for papillary and follicular thyroid carcinoma. Thyroid. 1997;7:265-71.
https://doi.org/10.1089/thy.1997.7.265
42. Cohen E, Tuttle M, Kraus D. Postoperative management of differentiated thyroid cancer. Otolaryngol Clin North Am. 2003;36:129-57.
https://doi.org/10.1016/S0030-6665(02)00137-8
43. Novelli JL, Sánchez A. La TSH recombinante humana en el se- guimiento del cáncer diferenciado de tiroides. En: Novelli JL, Sánchez A. Seguimiento del cáncer de tiroides. Rosario: UNR Editora; 2007. p. 221-8.
44. Vini L, Harmer C. Management of thyroid cancer. Lancet Oncol. 2002;3:12-29.
https://doi.org/10.1016/S1470-2045(02)00787-8
45. Clayman G, El Baradie T. Medullary thyroid cancer. Otolaryngol Clin North Am. 2003;36:91-105.
https://doi.org/10.1016/S0030-6665(02)00136-6
46. Massoll N, Mazzaferri ET. Diagnosis and management of medullary thyroid carcinoma. Clin Lab Med. 2004;24:49-83.
https://doi.org/10.1016/j.cll.2004.01.006
47. Yen T, Shapiro S, Gagel R, Sherman S, Lee J, Evans D. Medullary thyroid carcinoma: Results of a standarized surgical approach in contemporary series of 80 consecutive patients. Surgery. 2003;134:890-901.
https://doi.org/10.1016/S0039-6060(03)00408-2
48. Russell C, van Heerden J, Sizemore G, Edis A, Taylor W, Remine W, et al. The surgical management of medullary thyroid carci- noma. Ann Surg. 1983;1:42-8.
https://doi.org/10.1097/00000658-198301001-00007
49. Elisei R, Bottici V, Luchetti F, Di Coscio J, Romey C, Grasso L, et al. Impact of routine measurement of serum calcitonin on the diagnosis and outcome of medullary thyroid Cancer: Experience in 10,864 patients with nodular thyroid disorders. J Clin Endocrinol Metab. 2004;1:163-8.
https://doi.org/10.1210/jc.2003-030550
50. Sniezek J, Holtel M. Rare tumors of the thyroid gland. Otolaryngol Clin North Am .2003;36:107-15.
https://doi.org/10.1016/S0030-6665(02)00134-2
51. Wiseman S, Loree T, Hicks W, Rigual N, Winston J, Tan D, et al. Anaplastic thyroid cancer evolved from papillary carcinoma. Arch Otolaryngol Head Neck Surg. 2003;129:96-100.
https://doi.org/10.1001/archotol.129.1.96
52. Soung LW, Lin JD, Sohuang H, Chao T. Does surgery improve the survival of patients with advanced anaplastic thyroid carci- noma? Otolaryngol Head Neck Surg. 1998;118:728-31.
https://doi.org/10.1177/019459989811800532
53. Melliere D, Berrahal D, Bequemin J. Cancers anaplasiques de la thyroide. La guerison est-elle possible? Chirugie. 1999;124:52-7.
https://doi.org/10.1016/S0001-4001(99)80042-7
54. Crevoisier R, Baudin E, Bachelot A, Lebolleux S, Travagli JP Caillou P, et al. Combined treatment of anaplastic thyroid carci- noma with surgery, chemotherapy, and hyperfractionated accelerated external radiotherapy. Int J Radiat Oncol Biol Phys. 2004;60:312-5.
https://doi.org/10.1016/j.ijrobp.2004.05.032
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