Lobectomy may be more appropriate for patients with early-stage medullary thyroid cancer older than 60 years old

Yang, Bian; Niu, Gaungcai; Li, Xiaoxin; Ma, Fengwang; Ma, Yan; Hu, Shibin

doi:10.3389/fendo.2022.1015319

Cited by 9 publications

(12 citation statements)

References 31 publications

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“…An international, multicenter series from 1983 to 2011 of 313 patients with sporadic MTC showed a 5.6% rate of bilateral foci 12 on final pathology but did not examine whether those were detectable tomy with ipsilateral central neck dissection. 13,14 The safety of this approach in select patients with MTC has already been shown in previous studies, 7,10 although they did not quantify the risk of undetected foci of MTC in the contralateral lobe. Many thyroid specialists may also recommend total thyroidectomy not to remove occult contralateral foci, but rather to facilitate surveillance with serum calcitonin.…”

Section: Discussionmentioning

confidence: 96%

“…The low rate of contralateral foci should allow select patients to undergo a staged approach to surgery, beginning with initial thyroid lobectomy with ipsilateral central neck dissection . The safety of this approach in select patients with MTC has already been shown in previous studies, although they did not quantify the risk of undetected foci of MTC in the contralateral lobe.…”

Section: Discussionmentioning

confidence: 99%

“…Excision of the normal contralateral lobe adds unnecessary operative risk for an undefined benefit in patients with unifocal, sporadic MTC. Indeed, some series suggest that survival outcomes are similar following thyroid lobectomy and total thyroidectomy in select patients with MTC …”

Section: Introductionmentioning

confidence: 99%

“…Indeed, some series suggest that survival outcomes are similar following thyroid lobectomy and total thyroidectomy in select patients with MTC. 6,7 Proponents of total thyroidectomy argue that the contralateral lobe may contain additional foci of MTC. Up to 25% of cases of MTC represent hereditary forms attributed to germline variants in the RET proto-oncogene.…”

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confidence: 99%

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Extent of Surgery for Medullary Thyroid Cancer and Prevalence of Occult Contralateral Foci

Mao,

Hughes,

Steinmetz

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceStandard treatment for patients with medullary thyroid cancer (MTC) consists of total thyroidectomy with central neck dissection, but the rationale for bilateral surgery in patients with unilateral disease on ultrasonography remains unclear.ObjectiveTo determine the presence of occult contralateral disease (lesions not seen on preoperative ultrasonography) in patients with MTC as a rationale for total thyroidectomy.Design, Setting, and ParticipantsThis multi-institutional, retrospective cohort study was conducted from September 1998 to April 2022 in academic medical centers and included patients with MTC who underwent thyroidectomy with preoperative imaging.Main Outcomes and MeasuresThe primary end point was the prevalence of sonographically occult foci of MTC in the contralateral lobe among patients with sporadic MTC.ResultsThe cohort comprised 176 patients with a median age at diagnosis of 55 years (range, 2-87 years), 69 (57.6%) of whom were female. Genetic testing was performed in 109 patients (61.9%), 48 (27.5%) of whom carried germline RET variants. Initial surgical management consisted of total thyroidectomy (161 [91.0%]), lobectomy followed by completion thyroidectomy (7 [4.0%]), and lobectomy alone (8 [4.5%]). Central and lateral neck dissections were performed as part of initial therapy for 146 patients (83.1%). In the entire cohort of 176 patients, 46 (26.0%) had contralateral foci disease and 9 (5.1%) had occult contralateral foci that were not identified on preoperative ultrasonography. Among 109 patients who underwent genetic testing, 38 (34.9%) had contralateral disease, 8 (7.3%) of whom had occult contralateral disease not seen on preoperative ultrasonography. Patients with sporadic MTC experienced a 95.7% reduction in the odds of having a focus of MTC in the contralateral lobe compared with patients with a germline RET variant (odds ratio, 0.043; 95% CI, 0.013-0.123). When adjusting for age, sex, tumor size, and lymph node involvement, the odds ratio of having contralateral MTC in patients with sporadic disease was 0.034 (95% CI, 0.007-0.116). Among patients who underwent lobectomy alone with postoperative calcitonin levels, 5 of 12 (41.7%) achieved undetectable calcitonin levels (&lt;2.0 pg/mL; to convert to pmol/L, multiply by 0.292).Conclusions and RelevanceThe results of this cohort study suggest that a staged approach involving initial thyroid lobectomy could be considered in patients with sporadic MTC and no contralateral ultrasonography findings, with no further surgery if calcitonin levels became undetectable. Further work using prospective randomized clinical trials to evaluate lobectomy as a biochemical cure in patients presenting with unilateral disease is warranted.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Extent of Surgery for Medullary Thyroid Cancer and Prevalence of Occult Contralateral Foci

Mao,

Hughes,

Steinmetz

et al. 2024

JAMA Otolaryngol Head Neck Surg

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show abstract

“…They found no incidence of contralateral disease. Yang et al reported lobectomy as an appropriate treatment for those older than 60 years. Essig et al reported multifocality in sporadic medullary carcinoma in their multicenter international study.…”

mentioning

confidence: 99%