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2011, Número 2

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Cir Cir 2011; 79 (2)


Recurrencia del cáncer papilar de tiroides con tiroidectomía total y terapia adyuvante o con cirugía limitada en grupos de bajo riesgo

Hurtado-López LM, Melchor-Ruan J, Basurto-Kuba E, Montes de Oca-Durán ER, Pulido-Cejudo A, Athié-Gutiérrez C

Idioma: Español
Referencias bibliográficas: 45
Paginas: 118-125
Archivo PDF: 307.26 Kb.


RESUMEN

Introducción: Existe controversia en la extensión quirúrgica y el tratamiento adyuvante en el carcinoma papilar tiroideo de bajo riesgo. Objetivo: evaluar si en pacientes de bajo riesgo existe diferencia en la recurrencia con tiroidectomía total más adyuvancia y con cirugía limitada.
Material y métodos: Estudio longitudinal, observacional, analítico, de 184 pacientes con diagnóstico histopatológico de cáncer papilar de tiroides clasificados como de bajo riesgo por medio de TNM, MACIS, AMES y DeGroot, con un mínimo de 10 años de seguimiento. Los pacientes fueron divididos en dos grupos: uno con tiroidectomía total más tratamiento adyuvante (TT) y otro control con cirugía limitada sin complementación (HT). El análisis se efectuó por medio de estadística descriptiva e inferencial.
Resultados: AMES: 184 pacientes, recurrencia en 5/23 HT y 7/161 TT (p = 0.0016). MACIS: 170 pacientes, recurrencia en 5/24 HT y 5/146 TT (p = 0.0008). DeGroot: 92 pacientes, recurrencia en 3/19 HT y 2/73 TT (p = 0.0254). TNM: 150 pacientes, recurrencia en 5/22 HT y 7/128 TT (p = 0.0058). Las recurrencias locales tardaron más tiempo en manifestarse que las regionales (p ‹ 0.05). En todas las clasificaciones la recurrencia se manifiesta predominantemente con metástasis regionales (60%). La multicentricidad, bilateralidad y extensión extracapsular no mostraron diferencia significativa. Se presentó una lesión de nervio laríngeo recurrente incidental, reparada durante el mismo procedimiento; no existió hipoparatiroidismo.
Conclusiones: Por cualquier clasificación en pacientes de bajo riesgo existió mayor recurrencia con la hemitiroidectomía que con la tiroidectomía total más adyuvancia.


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