title: Initial lymph node dissection increases cure rates in patients with medullary thyroid cancer.
abstract: OBJECTIVE
  Medullary thyroid carcinoma (MTC) is the third most common type of thyroid cancer. MTC spreads early to local lymph nodes, and most endocrine surgeons recommend total thyroidectomy with central lymph node dissection (CLND) as the minimum initial operation. We reviewed our experience to determine if the initial operation influences clinical outcomes.
  
  
  METHODS
  Twenty-two patients with sporadic or inherited MTC who received surgery at one academic centre between 1994 and 2004 were identified. Clinical, operative, and pathology findings were reviewed.
  
  
  RESULTS
  Ten patients had prophylactic thyroidectomy for hereditary MTC, while 12 patients underwent therapeutic operations for sporadic MTC. The average age of the prophylactic group was 11 +/- 3, and 43 +/- 6 years for the therapeutic group. All patients in the prophylactic group received thyroidectomy without neck dissection. No patient in the prophylactic group had residual disease or required re-operation. In the therapeutic surgery group, three patients were treated with thyroidectomy plus CLND, and nine patients received thyroidectomy alone. The CLND group had a significantly higher cure rate as demonstrated by a lower incidence of residual disease (0% vs. 89%, p = 0.018), and re-operations (0% vs. 78%, p = 0.045).
  
  
  CONCLUSIONS
  Initial CLND for MTC increases cure rates by reducing residual disease and re-operations.
authors.affiliation: Department of Surgery, University of Wisconsin, Madison, Wisconsin, USA.
authors.forename: David Yü
authors.initials: DY
authors.lastname: Greenblatt
authors.forename: Diane
authors.initials: D
authors.lastname: Elson
authors.forename: Eberhard
authors.initials: E
authors.lastname: Mack
authors.forename: Herbert
authors.initials: H
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D018276:Carcinoma, Medullary / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy