The Surgical Treatment of Choice for Patients with Differentiated Thyroid Cancer(DTC)

분화성 갑상선암 환자에서 수술범위의 선택

Background: There is considerable controversy concerning the most appropriate surgical treatment of patients with DTC. Objectives: In order to selection of the appropriate surgical treatment for DTC, we have analyzed the outcome of the different types of surgical treatment in low and high risk groups of DTC. Materials and Methods: From January 1968 through december 1980, a total of 71 patients with DTC were treated surgically at our institution. According to Cady and Rossi's scoring system, the patients were divided into low risk and high risk groups. Results: Seventy percent of patients were defined as low risk group with a 4% death rate whereas 30% of patients at high risk with a death caused by thyroid cancer in 38%(p<0.05). There was no difference in mortality between ipsilateral lobectomy and total thyroidectomy in both low and high risk groups(p>0.1). Conclusion: In our study, total thyroidectomy was not benefit in high risk group. These results suggested that total thyroidectomy must be selected carefully and based on clear evidence of major improvement in outcome or absence of other suitable surgical approaches. However, follow up study of more cases will be needed for accurate determination of the efficacy of total thyroidectomy in high risk group.

결론적으로 저위험군환자에서는 수술방법 및 수술후 보조적인 치료법인 방사선요드동위원소 치료 및 갑상선 흐르몬 억제 치료가 생존을 증가에 별다른 영향을 주지 않으리라 생각된다. 이러한 이유는 사실상 이들 환자에서는 사망률의 위험성이 거의 없어 생존율을 확인할 방법이 없기 때문이다. 따라서 저위험군에서는 광범위한 수술방법을 피하고 고위험군에서는 환자 개개인의 상태에 따라 수술방법이 선택되어야 하며 갑상선 전절제술은 확실한 예후의 증가나 다른 적절한 치료 방법이 없을 경우 조심해서 선택되어야 된다고 사료된다.