title: Neck management in medullary thyroid carcinoma.
abstract: OBJECTIVE
  The aims of this study were to retrospectively evaluate incidence and patterns of lymph node metastases, surgical treatment and prognostic factors of medullary thyroid carcinoma.
  
  
  METHODS
  Out of a group of 70 MTC patients data of 67 patients were collected. Sixty-two of these patients underwent surgery. Apart from thyroidectomy, 16 patients underwent a bilateral neck dissection, 21 a unilateral neck dissection and 29 a paratracheal dissection or node-picking operation. Thirty-six patients were irradiated, of which 31 postoperatively and five with palliative intent.
  
  
  RESULTS
  Lymph node metastases were found in 91% of the ipsilateral neck dissection specimens, 91% of the paratracheal dissections and 63% of the contralateral dissections. Of the 12 elective neck dissections, 5 were tumor positive. Level VI was positive in 91% of the cases where a dissection was done, whereas preoperatively only 16% were scored tumor positive. During follow-up 22 of the 67 patients developed one or more locoregional recurrences (in total 28 recurrences). The most important factors that were correlated with a worse prognosis of survival were late stage of disease (stage III and IV) (p=0.0014), high number of positive lymph nodes (p=0.0023) and incomplete surgical resection (p=0.0002).
  
  
  CONCLUSIONS
  The high rate of locoregional recurrences in this study are a strong argument for a more aggressive approach to the primary and neck. A routine central and ipsilateral selective neck dissection of levels II-V should be considered in all MTC patients based on the high incidence of metastases and the relative low morbidity of a unilateral neck dissection. Patients referred after thyroidectomy alone with elevated (stimulated) calcitonin levels should be re-operated, performing an elective or therapeutic central and unilateral neck dissection.
authors.affiliation: Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. im.oskam@vumc.nl
authors.forename: I M
authors.initials: IM
authors.lastname: Oskam
authors.forename: F
authors.initials: F
authors.lastname: Hoebers
authors.forename: A J M
authors.initials: AJ
authors.lastname: Balm
authors.forename: F
authors.initials: F
authors.lastname: van Coevorden
authors.forename: E M
authors.initials: EM
authors.lastname: Bais
authors.forename: A M
authors.initials: AM
authors.lastname: Hart
authors.forename: M W M
authors.initials: MW
authors.lastname: van den Brekel
mesh_terms: D000328:Adult; D018276:Carcinoma, Medullary / Q000473:pathology* / Q000628:therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000628:therapy