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2017-02-17 发布于河南
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shah ppt.ppt

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shah ppt

* * * * * * * * * * * * * * * * * * * * * * * Selection of Therapy Low risk Unifocal intraglandular tumor in all age groups Lobectomy Be Aggressive at Extremes of Age High risk tumor in all age groups Total Thyroidectomy Aggressive surgery Children 16 yrs . Total thyroidectomy and RAI therapy Older patients 60 yrs . Appropriate aggressive Surgery followed by RAI and/or RT Adults Total Thyroidectomy Diffuse bilobar tumor Bilateral nodules regardless of the size of primary Major extrathyroid extension Massive bilateral nodal metastases Distant metastases History of radiation exposure Extrathyroid Extension from Differentiated Cancer of the Thyroid Gland Strap muscles Soft tissues Recurrent laryngeal nerve Minor: T3 Trachea Larynx Esophagus Major: T4A 0 10 20 30 40 50 60 70 80 90 100 No ETE 94% ETE 74% No Extrathyroid Extension n 1608 Extrathyroid Extension n 202 P 0.01 0 5 10 15 20 Time Years % Differentiated Carcinoma of the ThyroidSURVIVAL: Extrathyroid Extension Local Regional Distant Differentiated Carcinoma of the ThyroidETE and Recurrence Young Patients with Complete Excision Survival Time months 0.0 .1 .2 .3 .4 .5 .6 .7 .8 .9 1.0 0 60 120 180 240 300 360 p 0.46 p 0.005 45, ETE, Complete excision 45, No ETE 45, ETE, Incomplete excision Thyroid Carcinoma with Extrathyroid Extension Invasion of Trachea Shaving tumor off the trachea Resection of trachea with cricoid Trachea Partial/window resection and reconstruction Sleeve resection with primary anastomosis Surgery for Extrathyroid Extension AJCC/UICC 2009 Staging Nodal Staging for Thyroid Cancer Nx – regional lymph nodes cannot be assessed N0 – No regional lymph node metastases N1 – Regional lymph node metastases N1a Metastases to Level VI pretracheal, paratracheal, prelaryngeal, delphian N1b Metastases to unilateral, bilateral or contralateral cervical or superior mediastinal lymph nodes Central Compartment Node Dissection Modified Radical Neck D