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[Decision making in postoperative incidentally found small C-cell-carcinoma]
A Raffel1, K Cupisti, M Krausch
1Klinik für Allgemein- und Viszeralchirurgie, Heinrich-Heine-Universität, Universitätsklinikum Düsseldorf. raffel@med.uni-duesseldorf.de
Zentralblatt Fur Chirurgie
|October 13, 2005
Summary
For incidentally discovered small sporadic medullary thyroid cancer (MTC), completion thyroidectomy and neck dissection may not be necessary if the tumor is fully removed and no genetic RET Proto-Oncogen mutations are found. Long-term follow-up is essential.
Area of Science:
- Endocrinology
- Surgical Oncology
- Genetics
Context:
- Management of incidentally discovered small sporadic medullary thyroid cancer (MTC) remains controversial.
- Standard surgical therapy for known MTC involves total thyroidectomy and neck dissection.
- This study focuses on a cohort of patients with incidentally diagnosed MTC.
Purpose:
- To evaluate the necessity of completion thyroidectomy and neck dissection for incidentally diagnosed small sporadic MTC.
- To assess the outcomes of less extensive surgical approaches in these patients.
- To determine the role of long-term follow-up in managing this condition.
Summary:
- Twenty-two patients with incidentally diagnosed small sporadic MTC (pT1 or pT2) underwent less than total thyroidectomy.
- Mutation analysis for RET Proto-Oncogen and familial history were negative in all cases.
- All patients achieved cure with a median follow-up of 6.2 years (range: 2-13 years) after less extensive surgery, highlighting the importance of systematic follow-up.
Impact:
- Suggests that completion thyroidectomy and neck dissection may be avoidable in select cases of incidentally discovered MTC.
- Emphasizes the critical role of rigorous, long-term patient surveillance (at least 10 years, preferably lifelong) for detecting recurrence.
- Provides evidence to potentially refine surgical guidelines for managing small, sporadic MTC detected postoperatively.