International Journal of Head and Neck Surgery

Register      Login

VOLUME 2 , ISSUE 1 ( January-April, 2011 ) > List of Articles

RESEARCH ARTICLE

Choice of the Optimal Volume of Surgery for Patients with Sporadic Medullary Thyroid Cancer

Anatoly F Romanchishen, OV Lisovsky, KV Vabalayte

Citation Information : Romanchishen AF, Lisovsky O, Vabalayte K. Choice of the Optimal Volume of Surgery for Patients with Sporadic Medullary Thyroid Cancer. Int J Head Neck Surg 2011; 2 (1):11-15.

DOI: 10.5005/jp-journals-10001-1041

Published Online: 00-04-2011

Copyright Statement:  Copyright © 2011; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Objectives

Influence of lymphatic metastases at immediate and follow-up results of patients’ surgical treatment is controversial, especially for sporadic medullary thyroid carcinoma (SMTC).

Methods

A total of 3330 thyroid cancer patients were operated on (1973-2009), among them 226 (6.8%) were medullary thyroid cancer (MTC) patients. In 11 observations, MTC appeared as a part of MEN syndrome. Sporadic character of disease was confirmed in 215 (95.1%) cases. There were 140 (80.8%) females and 33 (19.2%) males (4.2:1.0) with average age 48.6 ± 2.7. Long-term results (1-40 yrs) were investigated in 173 (94.2%) cases. All SMTC patients were divided in to three groups. Group 1 made of 80 (46.2%) T1- 3N0M0, Group 2 of 47 (27.3%) T1-3N1a-bM0, Group 3 of 46 (26.6%) T4N1a-bM0 patients.

Results

Group1: Organ-sparing operations were carried out in 59 (73.7%), thyroidectomies in 21 (26.3%) patients. Multicentric tumor growth (MTG) was observed in 19.1%: in T1 cases - 5.7%, T2 - 20.5%, T3 - 46.7%. All patients underwent ipsilateral prophylactic central neck dissection (CND). Average period of postoperative observation (APPO), 12.0 ± 1.7. 5 years survival rate made 98.4%, 10-91.7%. Local relapse of MTC was found in one patient (in contralateral thyroid lobe).

Group 2: Organ-sparing operations were carried out in 20 (42.6%), thyroidectomies—27 (57.4%) with curative central or central and lateral lymphadenectomy (LAE). MTG took place in 47.2%. Six group metastases only (T1a) were found in 38.9% and CND was performed. In other cases (61.1%), CND, lateral and mediastinal (8.3%) LAE were performed. APPO correspondent to 10.8 + 2.1 years. Repeated LAE because lymphatic metastases were carry out in 15 (31.9%) patients through 7.2 ± 2.4 years in average after initial operations. Tumor relapses were not found in thyroid remnant. Five-year survival rate made 89.2%, 10-67.8%.

Group 3: MTG was observed in 64.3%. Central compartment group lymphatic metastases were revealed in 93.3%, in 2 to 5 groups – 86.7%, in mediastinum – 38.5%, distant metastases – in 22.0%. Combined operations were performed in 58.9%, palliative in 45 (26.6 %) cases. Operations were completed by tracheostomy in 38.4%. Adjuvant therapy (X-ray, chemotherapy) was applied in 28.9%. Postoperative lethality made 6.5%. APPO corresponded to 3.3 ± 0.8 (1-10 yrs). During first year, eight patients have died. Five-year survival rate made 32.4%.

Conclusion

Detection of regional metastases of SMTC during the first patient presentation significantly worsen survival rate. Early diagnosis of SMTC by calcitonin level detection is the best way to improve results of treatment. Organ-sparing thyroidectomies with mandatory ipsilateral prophylactics CND are justified only at T1N0M0 sporadic MTC.


PDF Share
  1. Cancer of the head and neck. Hamilton. London: BS Decker Inc 2001;484.
  2. Multiple endocrine neoplasia type IIb: The most aggressive form of medullary thyroid carcinoma. Surg. Clin North Am 1979;59(1):109-18.
  3. Familial multiple endocrine neoplasia syndromes: Components, classification and nomenclature. J Intern Med 1998;243(6):425-32.
  4. Long-term management of differentiated thyroid cancer. Endocr Metab Clin. North Am 1990;19(3):719-39.
  5. Nonfamilial medullary thyroid carcinoma. Am J Surg 1980;139(4):554-60.
  6. Thyroidectomy for non-familial medullary carcinoma. Brit J Surg 1976;63(5):632-42.
  7. Clinic of sporadic and familial variants of medullary thyroid carcinoma. Actual problems of modern endocrinology: Theses of All-Russian Endocrinologists Congress. Saint-Petersburg 2001;305.
  8. Determinative factors of biochemical cure after primary and reoperative surgery for sporadic medullary thyroid carcinoma. World J Surg 1998; 22(6):562-68.
  9. Experience of medullary thyroid cancer treatment. Actual problems of modern endocrinology: Theses of All-Russian Endocrinologists Congress. Saint-Petersburg 2001;273.
  10. Medullary thyroid carcinoma: Clinico-prognostic features and long-term follow-up of 65 patients treated during 1946 through 1970. Mayo Clin. Proc 1992;67(10):934-40.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.