Impact of modified radical neck dissection on biochemical cure in medullary thyroid carcinomas.
BACKGROUND
This study evaluated the outcome of total thyroidectomy and modified radical neck dissection in primary treatment of patients with medullary thyroid carcinoma (MTC).


METHODS
Thirty-six patients with sporadic (n = 16) and hereditary (n = 20) MTC underwent thyroidectomy and systematic central and lateral lymph node dissection (unilateral, 23; bilateral, 13) between 1994 and 2000. Postoperative serum calcitonin levels were correlated with immediate or delayed surgery, tumor categories, and lymph node metastases.


RESULTS
Sixteen of 36 (44%) patients with clinically evident MTC treated with central and lateral neck dissection exhibited normal basal and stimulated calcitonin levels at a median follow-up of 3.7 years. Lymph node involvement was detected in 75% of these patients and correlated with the TNM stages. Biochemical cure was achieved according to the T categories in 83% of the patients in stage T1, 42% in stage T2, and none of the patients in stage T4 (P = .011). Basal and stimulated calcitonin levels were found to be normal in 89% of the patients without lymph node involvement and in 30% of the patients with lymph node metastases (P = .005).


CONCLUSIONS
Screening for MTC and primary treatment with total thyroidectomy and modified radical neck dissection are essential for biochemical cure of MTC.
Weber
T
T
Department of Surgery, University of Heidelberg, and Endokrinologische Gemeinschaftspraxis, Heidelberg, Germany.
Schilling
T
T
Frank-Raue
K
K
Colombo-Benkmann
M
M
Hinz
U
U
Ziegler
R
R
Klar
E
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D002116:Calcitonin / Q000097:blood; D002118:Calcium / Q000097:blood; D018276:Carcinoma, Medullary / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy
D002116:Calcitonin; D002118:Calcium