title: Impact of modified radical neck dissection on biochemical cure in medullary thyroid carcinomas.
abstract: 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.
authors.affiliation: Department of Surgery, University of Heidelberg, and Endokrinologische Gemeinschaftspraxis, Heidelberg, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Weber
authors.forename: T
authors.initials: T
authors.lastname: Schilling
authors.forename: K
authors.initials: K
authors.lastname: Frank-Raue
authors.forename: M
authors.initials: M
authors.lastname: Colombo-Benkmann
authors.forename: U
authors.initials: U
authors.lastname: Hinz
authors.forename: R
authors.initials: R
authors.lastname: Ziegler
authors.forename: E
authors.initials: E
authors.lastname: Klar
mesh_terms: 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
chemical_list: D002116:Calcitonin; D002118:Calcium