Contenido principal del artículo

Fernando López
Servicio ORL y CCC. Hospital Universitario Central de Asturias. Oviedo.
España
https://orcid.org/0000-0001-7019-9746
Biografía
Patricia García-Cabo
Servicio de Otorrinolaringología. Hospital Universitario Central de Asturias. Oviedo. España
España
https://orcid.org/0000-0003-2542-163X
Biografía
Laura Fernández-Vañes
Servicio de Otorrinolaringología. Hospital Universitario Central de Asturias. Oviedo. España
España
https://orcid.org/0000-0001-8196-9099
Biografía
Andrés Coca-Pelaz
1Servicio de Otorrinolaringología. Hospital Universitario Central de Asturias. Oviedo. España. 2Universidad de Oviedo. Instituto de Investigación Sanitaria del Principado de Asturias (ISPA). España
España
https://orcid.org/0000-0003-1363-8559
Biografía
Juan Pablo Rodrigo
1Servicio de Otorrinolaringología. Hospital Universitario Central de Asturias. Oviedo. España. 2Universidad de Oviedo. Instituto de Investigación Sanitaria del Principado de Asturias (ISPA). España
España
https://orcid.org/0000-0003-3063-0890
Biografía
José Luis Llorente
1Servicio de Otorrinolaringología. Hospital Universitario Central de Asturias. Oviedo. España. 2Universidad de Oviedo. Instituto de Investigación Sanitaria del Principado de Asturias (ISPA). España
España
https://orcid.org/0000-0001-7713-5526
Biografía
Vol. 12 Núm. 4 (2021), Artículo de revisión, Páginas 325-340
DOI: https://doi.org/10.14201/orl.23924
Derechos de autor Cómo citar

Resumen

Introducción y objetivo: El número de pacientes con microcarcinoma papilar de la tiroides (mPTC) cada vez es más elevado. Las guías de práctica clínica han respaldado tanto la vigilancia activa como la cirugía como opciones de tratamiento para el (mCPT). En esta revisión nos planteamos como objetivo describir las opciones actuales de manejo del mCPT. Síntesis: La evidencia acumulada en los estudios realizados ha permitido conocer la historia natural y el comportamiento biológico de estos tumores. Mediante las extensas experiencias, se ha evidenciado que la gran mayoría de estos tumores muchas veces no presentan una variación significativa de su tamaño, o presentan tasas de crecimiento muy lentas, e incluso algunos presentan disminución de éste. La mayoría de mCPT son tumores de bajo riesgo clínico que no generarán morbilidad o mortalidad a pesar de no ser tratados. En los últimos años, la práctica clínica ha evolucionado hacia un tratamiento menos agresivo de estos mCPT para evitar la morbilidad derivada del tratamiento activo mediante cirugía y/o radioyodo y/o supresión hormonal. Los pacientes con tumores de alto riesgo deben ser manejados siguiendo los protocolos de los carcinomas papilares. Sin embargo, la vigilancia activa (VA) de pacientes con tumores de bajo riesgo ha mostrado excelentes resultados oncológicos sin aumentar la morbilidad y la mortalidad. Cuando se indica un tratamiento quirúrgico, la lobectomía es una opción válida para estos tumores. Los criterios de selección inicial para la idoneidad de ser manejados mediante VA deben tener en cuenta muchos aspectos, incluidas las características de los tumores y pacientes. En caso de alto riesgo de progresión deben ser sometidos a una cirugía inmediata en lugar de VA. Conclusiones: La VA ha surgido como una nueva alternativa terapéutica para estos tumores de bajo riesgo, con excelentes resultados oncológicos y menores tasas de complicaciones. No obstante, a pesar de los alentadores resultados de la VA, su implementación en la práctica depende de muchos aspectos entre los cuales se encuentran las características del tumor, las características clínicas del paciente y factores psicosociales.

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