title: Surgical strategies in patients with medullary thyroid carcinoma.
abstract: OBJECTIVE
  Aim of the study was to identify, in 59 operated patients affected by medullary thyroid carcinoma (MTC), the recurrence rate, survival, mortality and incidences of surgically derived hypoparathyroidism and recurrent laryngeal nerve injury (RLNI).
  
  
  METHODS
  Based on pre-surgical diagnosis of the 59 patients included in the study, 35 underwent total thyroidectomy with central neck dissection (Group A), 14 total thyroidectomy, central neck dissection and monolateral functional neck dissection (Group B) and 10 total thyroidectomy central neck dissection, bilateral functional neck dissection (Group C). Overall survival, recurrences, incidence of hypoparathyroidism and RLNI were evaluated.
  
  
  RESULTS
  The survival and recurrences were not statistically different among the three Groups. In Group B there was major probability of re-operation (p=0.042). The mortality rate was clearly major in Group C (p=0.003) due to the stage of pathology. Group C showed a high number of hypoparatiroidism compared to Group B, and B compared to A. In Group A there was only one unexpected RLNI; in 5 cases, 3 in Group B and 2 in Group C, there were a necessity laringeal section due to nerve tumor involvement.
  
  
  CONCLUSIONS
  From our data it appears clearly that disease outcome following the different surgical approaches is mainly determinated by the stage of the disease at diagnosis. However, the finding that patients in Group A and B showed a high rate of local-regional recurrences may suggest that homolateral lymphadenectomy in Group A patients and bilateral lymphadenectomy in Group B patients should be always performed.
authors.affiliation: Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy. salvatore.sorrenti@uniroma1.it
authors.forename: S
authors.initials: S
authors.lastname: Sorrenti
authors.forename: E
authors.initials: E
authors.lastname: Guaitoli
authors.forename: A
authors.initials: A
authors.lastname: Catania
authors.forename: V
authors.initials: V
authors.lastname: D'Andrea
authors.forename: F M
authors.initials: FM
authors.lastname: Di Matteo
authors.forename: M
authors.initials: M
authors.lastname: Nardi
authors.forename: N
authors.initials: N
authors.lastname: Prinzi
authors.forename: F
authors.initials: F
authors.lastname: Nardi
authors.forename: V
authors.initials: V
authors.lastname: Ascoli
authors.forename: E
authors.initials: E
authors.lastname: Baldini
authors.forename: S
authors.initials: S
authors.lastname: Ulisse
authors.forename: E
authors.initials: E
authors.lastname: De Antoni
mesh_terms: D018278:Carcinoma, Neuroendocrine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000401:mortality / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*