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Timing and extension of lymphadenectomy in medullary thyroid carcinoma: A case series from a single institution
Andrea Polistena1, Alessandro Sanguinetti1, Roberta Lucchini1
1University of Perugia, Medical School, Endocrine Surgery Unit, S. Maria University Hospital, Terni, Italy.
Background:
Medullary thyroid carcinoma is an aggressive tumor and presents with significant morbidity and mortality and a high rate of lymph node metastases. The combination of total thyroidectomy and cervical lymphadenectomy is the essential treatment for those patients presenting with cervical lymph node metastases.
Materials And Methods:
A retrospective analysis of 117 patients operated for medullary thyroid carcinoma over a period of 15 years at a single institution. Surgical complications and calcitonin levels were noted.
Results:
Nodal metastases were detected in the central compartment in 72.6% patients. Positive lymph nodes were detected in the lateral compartment of 34 patients who had undergone ipsilateral dissection and in all 10 patients of those with bilateral surgery. We found 3 cases of unilateral transient recurrent laryngeal nerve palsy, 15 cases of temporary hypoparathyroidism, a permanent accessory nerve lesion and a case of chylous fistula. Normalization of post-operative calcitonin was found in 82.6% and of patients who underwent total thyroidectomy and central neck dissection alone compared to 35.4% in those with ipsilateral and bilateral neck dissection.
Conclusions:
Total thyroidectomy and cervical lymphadenectomy planned on the ultrasound preoperative study and on the calcitonin level represent the standard of treatment for medullary thyroid carcinoma.
