Improved Results of Cervical Reoperation for Medullary Thyroid Carcinoma

Moley, Jeffrey F.; Dilley, William G.; DeBenedetti, Mary K.

doi:10.1097/00000658-199706000-00011

Cited by 116 publications

(112 citation statements)

References 11 publications

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“…Chemotherapy based on dacarbazine has been associated with a significant reduction in tumor size in approximately 30% of patients treated with this agent in combination with others. However, neither a complete remission nor any effect on survival rates have been observed (27). In the present study, surgical complications resulted in hypoparathyroidism in 15.3% and recurrent laryngeal nerve injury in 11% of patients.…”

Section: Groups -----------------------------------------------------contrasting

confidence: 70%

Alternative surgical strategies in patients with sporadic medullary thyroid carcinoma: Long-term follow-up

et al. 2011

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Abstract. The extent of surgical resection in patients with sporadic medullary thyroid carcinoma (SMTC) remains controversial. The aim of the present study was to discuss the prognosis of sporadic medullary thyroid carcinoma with different surgical treatments. Of 73 patients with SMTC (mean age of 43.78 years at diagnosis), 70 patients were followed up for 12.0-169.0 months (median 90.0). Having given their informed consent, 12 patients underwent total thyroidectomy with bilateral central neck dissection (group A), 40 underwent subtotal thyroidectomy preserving contralateral thyroid tissue on the entrance point of the recurrent laryngeal nerve into the larynx with ipsilateral modified radical neck dissection (group B), and 18 patients underwent subtotal thyroidectomy preserving contralateral thyroid tissue on the entrance point of the recurrent laryngeal nerve into the larynx with bilateral modified radical neck dissection (group C). The diagnosis was confirmed by a pathology examination. The incidences of hypoparathyroidism and recurrent laryngeal nerve injury, the cancer recurrence rates and survival time were investigated post-operatively. Significant differences were found between groups A, B and C in the incidence of hypoparathyroidism (χ 2 =40.9, P<0.01), as well as that of recurrent laryngeal nerve injury (χ 2 =32.9, P<0.01). The cancer recurrence rates in groups A, B and C were 75.0% (9/12), 2.5% (1/40) and 44.4% (8/18) respectively, (χ 2 =31.1, P<0.01) and the cure rates were 25, 97.5 and 55.6% respectively (χ 2 =31.1, P<0.01). The mean survival times in groups A, B and C were 77.8, 106.1 and 111.0 months respectively, but significant difference was noted (χ 2 =3.2, P>0.05). In conclusion, compared to total thyroidectomy with bilateral central neck dissection, subtotal thyroidectomy with ipsilateral/bilateral modified radical neck dissection showed a lower incidence of hypoparathyroidism, recurrent laryngeal nerve injury and lower rates of recurrence, along with a similar cumulative survival.

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Section: Groups -----------------------------------------------------contrasting

confidence: 70%

Alternative surgical strategies in patients with sporadic medullary thyroid carcinoma: Long-term follow-up

et al. 2011

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“…These patients must be followed for the possibility to develop nodes metastases and immediately re-operated on before they become locally invasive or quite large. Although not definitively effective in terms of biochemical cure, this procedure proved to be useful in improving the overall survival (Tisell et al 1986, Moley et al 1997.…”

Section: Discussionmentioning

confidence: 99%

Clinically unpredictable prognostic factors in the outcome of medullary thyroid cancer

Miccoli¹,

Minuto²,

Ugolini³

et al. 2007

Endocrine Related Cancer

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Total thyroidectomy and central neck dissection are the procedures of choice in patients affected with medullary thyroid cancer. It is known that a medullary thyroid cancer with node metastases can be rarely cured, and therefore the utility of a modified radical neck dissection in the absence of suspicious node metastases still needs further evidence. The study aims to verify whether other epidemiological and pathological parameters could affect the prognosis of medullary thyroid cancer patients. We prospectively studied 70 medullary thyroid cancer patients consecutively operated on (from 2000 to 2004) at the same institution and analysed by the same pathologists. All patients underwent total thyroidectomy and central lymphadenectomy. In 27 cases, the ipsilateral (nZ19) or bilateral (nZ8) modified radical neck dissection was performed in the presence of suspicious lateral neck node metastases. After surgical treatment, basal and stimulated serum calcitonins (Cts) were measured in all patients. Follow-up ranged between 1 and 4 years. Patients were considered 'cured' when stimulated Ct was undetectable. Age, sex, tumour size, tumour capsule, multicentricity, nodes in the central neck and mean number of positive nodes were analysed in 'cured' and 'not-cured' patients. The presence of node metastases in the central compartment was significantly correlated with the outcome of the patients, being present in 9 and 72% of cured and not-cured patients respectively (P!0.000001). Tumour size was also significantly correlated with the outcome of the disease (P!0.00006). The presence of the tumour capsule correlated with better prognosis (PZ0.0005) and absence of node metastases (PZ0.0080). By multivariate analysis, the presence of node metastasis remained the most significant variable affecting the outcome of the disease (PZ0.000014). Our results show that the outcome of encapsulated cancer is significantly better regardless of tumour size and node metastases. Although the early diagnosis and the extensive surgical treatment may favour the good outcome of medullary thyroid cancer, they do not always guarantee the definitive cure of the disease, being the capsular infiltration an independent bad prognostic factor.

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“…A more aggressive neck dissection should be performed if there is evidence of involved lymph nodes in the lateral neck. If the basal or stimulated plasma CT levels are high after primary thyroid surgery, it is important to define the extent of local and distant metastatic disease (102)(103)(104)(105)(106)(107). Then, a decision regarding reoperation must be made (108 -111).…”

Section: Mtc In Men2mentioning

confidence: 99%