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Repeat mediastinal lymph-node dissection for palliation in advanced medullary thyroid carcinoma
1Department of General Surgery, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany.
Langenbeck'S Archives of Surgery
|August 7, 1999
Summary
Repeat mediastinal lymph-node dissection effectively palliated symptoms in medullary thyroid carcinoma (MTC) patients. This surgical approach is recommended for discrete lesions inaccessible via a cervical route.
Area of Science:
- Oncology
- Surgical Oncology
- Endocrinology
Background:
- Effectiveness of repeat mediastinal lymph-node dissection for symptomatic medullary thyroid carcinoma (MTC) with non-bulky disease is not well-established.
- Mediastinal lymph node metastases can cause specific symptoms in MTC patients.
Purpose of the Study:
- To evaluate the efficacy of repeat mediastinal lymph-node dissection in palliating symptoms in MTC patients.
- To assess the feasibility and outcomes of reoperation for mediastinal lymph node metastases.
Main Methods:
- Five symptomatic MTC patients with mediastinal tumors and elevated calcitonin underwent repeat mediastinal lymph-node dissection between 1994 and 1998.
- Histopathological analysis of resected lymph nodes from cervical and mediastinal regions was performed.
Main Results:
- Histopathology confirmed lymph node metastases in 28% of cervical and 56% of mediastinal nodes.
- All five patients experienced effective palliation of clinical symptoms.
- No mortality occurred; morbidity included transient hypoparathyroidism and a lymphatic fistula. Patients remained disease-free in the neck and mediastinum at 15-month follow-up.
Conclusions:
- Repeat lymph-node dissection is a viable option for palliating discrete mediastinal lesions in MTC.
- This procedure is particularly beneficial for lesions not amenable to a purely cervical surgical approach.