title: Fewer cancer reoperations for medullary thyroid cancer after initial surgery according to ATA guidelines.
abstract: BACKGROUND
  Surgery is still the only curative treatment for medullary thyroid cancer (MTC). We evaluated clinical outcome in patients with locoregional MTC with regard to adequacy of treatment following ATA guidelines and number of sessions to first intended curative surgery in different hospitals.
  
  
  METHODS
  We reviewed all records of MTC patients (n = 184) treated between 1980 and 2010 in two tertiary referral centers in the Netherlands. Symptomatic MTC (palpable tumor or suspicious lymphadenopathy) patients without distant metastasis were included (n = 86). Patients were compared with regard to adequacy of surgery according to ATA recommendations, tumor characteristics, number of local cancer reoperations, biochemical cure, clinical disease-free survival (DFS), overall survival (OS), and complications.
  
  
  RESULTS
  Adherence to ATA guidelines resulted in fewer cancer-related reoperations (0.24 vs. 0.60; P = 0.027) and more biochemical cure (40.9 vs. 20 %; P = 0.038). Surgery according to ATA-guidelines on patients treated in referral centers was significantly more often adequate (59.2 vs. 26.7 %; P = 0.026). Tumor size and LN+ were the most important predictors for clinical recurrence [relative risk (RR) 4.1 (size > 40 mm) 4.1 (LN+) and death (RR 4.2 (size > 40 mm) 8.1 (LN+)].
  
  
  CONCLUSIONS
  ATA-compliant surgery resulted in fewer local reoperations and more biochemical cure. Patients in referral centers more often underwent adequate surgery according to ATA-guidelines. Size and LN+ were the most important predictors for DFS and OS.
authors.affiliation: Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Hans H G
authors.initials: HH
authors.lastname: Verbeek
authors.forename: Johannes A A
authors.initials: JA
authors.lastname: Meijer
authors.forename: Wouter T
authors.initials: WT
authors.lastname: Zandee
authors.forename: Kelvin H
authors.initials: KH
authors.lastname: Kramp
authors.forename: Wim J
authors.initials: WJ
authors.lastname: Sluiter
authors.forename: Johannes W
authors.initials: JW
authors.lastname: Smit
authors.forename: Job
authors.initials: J
authors.lastname: Kievit
authors.forename: Thera P
authors.initials: TP
authors.lastname: Links
authors.forename: John Th M
authors.initials: JT
authors.lastname: Plukker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018276:Carcinoma, Medullary / Q000473:pathology* / Q000601:surgery*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis; D009367:Neoplasm Staging; D011183:Postoperative Complications; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery*; D013965:Thyroidectomy / Q000706:statistics & numerical data*; D055815:Young Adult