[The importance of lymph node dissection in medullary thyroid macrocarcinomas]

Area of Science:

• Endocrinology
• Surgical Oncology
• Oncology

Context:

• Medullary thyroid carcinoma (MTC) often presents with significant lymph node involvement.
• Despite good medium-term survival rates, persistent pathological calcitonin levels indicate evolving disease.
• Current treatments like thyroidectomy and lymphadenectomy are frequently incomplete, leading to disappointing reintervention outcomes.

Purpose:

• To demonstrate the importance of complete lymph node dissection in the neck for medullary thyroid carcinoma (MTC).
• To assess the impact of early and complete cervical lymphadenectomy on disease progression and calcitonin levels.

Summary:

• A study of 48 patients with macroMTC (size >1 cm) evaluated the efficacy of complete (central and lateral) neck dissection.
• Complete lymphadenectomies, performed initially or secondarily, resulted in an 81% rate of node involvement.
• Primary complete dissections in 22 cases normalized basal calcitonin levels in 59% and decreased them by over 90% in 77.2% of patients.

Impact:

• Complete lymph node dissection is essential for effective MTC management, with a high rate of node involvement (around 80%) and frequent bilaterality.
• Early surgical intervention with complete lymphadenectomy is critical for achieving calcitonin level normalization.
• The study highlights that complete lymphadenectomy is underutilized, emphasizing the need for its more frequent application in MTC treatment.