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김완욱 대한갑상선학회 2020 International Journal of Thyroidology Vol.13 No.2
The goal of thyroid cancer surgery is the complete removal of the cancer, verification that patients receiveappropriate treatment through accurate staging after surgery, minimization of local recurrence, and improvementof survival rate. However, maintaining the patient’s functional outcome and quality of life by minimizingpostoperative complications as well as having good oncological outcomes is also important. To determine theoptimal surgical extent, appropriate diagnosis and evaluation should be made on age, gender, tumor size, multiplicity,extrathyroidal extension, lymph node/distant metastasis, and biologic aggressiveness. In the low-risk group, lobectomyis required, and experienced high-volume surgeons may consider ipsilateral prophylactic central lymph nodedissection because of the acceptable risk of hypoparathyroidism. In the intermediate-risk group, personalizeddecision-making should be determined according to the patient’s preferences and characteristics while alsoconsidering the pros and cons of lobectomy or total thyroidectomy. For the patient with high-risk factors, totalthyroidectomy is considered. However, if a total thyroidectomy is not absolutely necessary and complications areexpected, lobectomy could be a second option. If the patient has central lymph node metastasis, a therapeuticcentral lymph node dissection must be performed, and in the case of high-risk groups (T3/4 and N1b), ipsilateralprophylactic node dissection should be considered, and the contralateral parathyroid gland should be preserved. In the high-risk group (especially with massive ipsilateral lymph node metastasis or gross extrathyroidal involvement),the surgeon may consider bilateral central lymph node dissection if the ipsilateral parathyroid gland and therecurrent laryngeal nerve are well preserved, because of the risk of contralateral lymph node metastasis.
Transoral Thyroidectomy: Advantages and Disadvantages
김완욱 대한내시경복강경외과학회 2020 Journal of Minimally Invasive Surgery Vol.23 No.3
To date, many remote-access thyroid surgery techniques using endoscopic or robotic instruments have been developed. Transoral thyroidectomy has attracted great attention as a scarless thyroidectomy and is performed worldwide. Each surgical method has its advantages and disadvantages: selecting the optimal surgical method according to each patient's condition and preferences will possibly result in obtaining the best results and achieving patient satisfaction while minimizing complications after surgery.
Predictive Risk Factors for Recurrence or Metastasis in Papillary Thyroid Cancer
김완욱,이지연,정진향,박호용,정지윤,박지영,Ralph P. Tufano 대한갑상선학회 2020 International Journal of Thyroidology Vol.13 No.2
Background and Objectives: This study investigated predictive risk factors for cervical nodal recurrence ormetastasis in papillary thyroid carcinoma (PTC). Materials and Methods: From September 2014 to February 2015,a total of 321 PTC patients were enrolled retrospectively. Except for 154 N0 patients, the remaining 167 patientswere divided into two groups as follows: Group I (n=140), central lymph node (LN) metastasis (pN1a); GroupII (n=27), lateral LN metastasis (pN1b, n=23) or LN recurrence (n=4). The patients who had LN metastasis orrecurrence underwent selective LN dissection or recurrent LN excision. Results: Central LN metastases were foundin 44.0% (142/321) of patients. Two hundred thirty patients (71.7%) were classified as being at low-risk forLN disease, as evidenced by N0 or fewer than five micrometastases. The mean size of central metastatic LNs was0.37±0.34 cm. A total of 76 patients (46.6%) presented with micrometastasis, and ten (3.1%) presented withextranodal extension (ENE). The multiple/bilateral cancer, Extrathyroidal extension, size of metastatic LN, ENE, highrisk LN disease (>5, macrometastasis, >3.0 cm) and high thyroglobulin were significant risk factors in predictingLN recurrence or lateral LN metastasis (p<0.05) in univariate analysis. Patients with ENE were 10.3 times moreat risk for recurrence or metastasis than patients without ENE. Conclusion: We consider the ENE was the mostpotent risk factors for LN recurrence or lateral LN metastasis in PTC.