E Kebebew1, S Kikuchi, Q Y Duh, O H Clark. 1. Department of Surgery, University of California-San Francisco, 513 Parnassus Ave, Mail Stop S343, San Francisco, CA 94134-0470, USA.
Abstract
HYPOTHESIS: Reoperation benefits patients with locoregional, persistent, or recurrent medullary thyroid cancer (MTC). Currently available localizing studies have limited utility for detecting all foci of residual MTC. DESIGN: A retrospective study with a mean follow-up time of 7.5 years (median, 13 years; range, 2.2-29 years). SETTING: A tertiary referral medical center. PATIENTS: Thirty-three patients who underwent 46 reoperations for locoregional residual MTC. RESULTS: Sixty-four percent of residual MTC was located in the lateral cervical nodes, 22% in the central cervical nodes or thyroid bed, and 14% in the anterior mediastinum (197 of 1128 nodes resected were positive for MTC). After reoperation, basal calcitonin levels were undetectable in 2 patients, reduced by greater than 50% in 10 patients, and either increased or were not reduced by greater than 50% in the remaining patients. On reoperation, one patient had a thoracic duct injury that required reexploration and ligation. Patients who had a greater than 50% decrease in calcitonin levels after reoperation were less likely to develop distant metastases compared with patients who did not have a greater than 50% decrease (P<.05). The sensitivities of magnetic resonance imaging (n = 31), computed tomographic scan (n = 16), ultrasound (n = 9), and dimercaptosuccinic acid scan (n = 3) were 91%, 86%, 88%, and 100%, respectively. CONCLUSIONS: Although reoperation in patients with residual MTC rarely results in biochemical cure, cervical reexploration is safe and in selected patients may limit MTC progression. Lateral cervical node dissection could be beneficial at the time of initial surgical treatment because of the high frequency of residual MTC in the lateral cervical nodes. Noninvasive imaging studies were helpful but far from perfect for guiding the reexploration for locoregional residual MTC.
HYPOTHESIS: Reoperation benefits patients with locoregional, persistent, or recurrent medullary thyroid cancer (MTC). Currently available localizing studies have limited utility for detecting all foci of residual MTC. DESIGN: A retrospective study with a mean follow-up time of 7.5 years (median, 13 years; range, 2.2-29 years). SETTING: A tertiary referral medical center. PATIENTS: Thirty-three patients who underwent 46 reoperations for locoregional residual MTC. RESULTS: Sixty-four percent of residual MTC was located in the lateral cervical nodes, 22% in the central cervical nodes or thyroid bed, and 14% in the anterior mediastinum (197 of 1128 nodes resected were positive for MTC). After reoperation, basal calcitonin levels were undetectable in 2 patients, reduced by greater than 50% in 10 patients, and either increased or were not reduced by greater than 50% in the remaining patients. On reoperation, one patient had a thoracic duct injury that required reexploration and ligation. Patients who had a greater than 50% decrease in calcitonin levels after reoperation were less likely to develop distant metastases compared with patients who did not have a greater than 50% decrease (P<.05). The sensitivities of magnetic resonance imaging (n = 31), computed tomographic scan (n = 16), ultrasound (n = 9), and dimercaptosuccinic acid scan (n = 3) were 91%, 86%, 88%, and 100%, respectively. CONCLUSIONS: Although reoperation in patients with residual MTC rarely results in biochemical cure, cervical reexploration is safe and in selected patients may limit MTC progression. Lateral cervical node dissection could be beneficial at the time of initial surgical treatment because of the high frequency of residual MTC in the lateral cervical nodes. Noninvasive imaging studies were helpful but far from perfect for guiding the reexploration for locoregional residual MTC.
Authors: Samuel A Wells; Sylvia L Asa; Henning Dralle; Rossella Elisei; Douglas B Evans; Robert F Gagel; Nancy Lee; Andreas Machens; Jeffrey F Moley; Furio Pacini; Friedhelm Raue; Karin Frank-Raue; Bruce Robinson; M Sara Rosenthal; Massimo Santoro; Martin Schlumberger; Manisha Shah; Steven G Waguespack Journal: Thyroid Date: 2015-06 Impact factor: 6.568
Authors: D Taïeb; S Giusiano; F Sebag; M Marcy; C de Micco; F F Palazzo; N J Dusetti; J L Iovanna; J F Henry; S Garcia; Colette Taranger-Charpin Journal: World J Surg Date: 2010-04 Impact factor: 3.352
Authors: Dana T Yip; Maria Hassan; Kalliopi Pazaitou-Panayiotou; Daniel T Ruan; Atul A Gawande; Randall D Gaz; Francis D Moore; Richard A Hodin; Antonia E Stephen; Peter M Sadow; Gilbert H Daniels; Gregory W Randolph; Sareh Parangi; Carrie C Lubitz Journal: Surgery Date: 2011-12 Impact factor: 3.982
Authors: Anish Jacob Cherian; Pooja Ramakant; Rekha Pai; Marie Therese Manipadam; S Elanthenral; Anuradha Chandramohan; Julie Hephzibah; David Mathew; Dhukabandhu Naik; Thomas V Paul; Simon Rajaratnam; Nihal Thomas; M J Paul; Deepak Thomas Abraham Journal: Indian J Surg Oncol Date: 2017-12-08
Authors: Henning Dralle; Thomas J Musholt; Jochen Schabram; Thomas Steinmüller; Andreja Frilling; Dietmar Simon; Peter E Goretzki; Bruno Niederle; Christian Scheuba; Thomas Clerici; Michael Hermann; Jochen Kußmann; Kerstin Lorenz; Christoph Nies; Peter Schabram; Arnold Trupka; Andreas Zielke; Wolfram Karges; Markus Luster; Kurt W Schmid; Dirk Vordermark; Hans-Joachim Schmoll; Reinhard Mühlenberg; Otmar Schober; Harald Rimmele; Andreas Machens Journal: Langenbecks Arch Surg Date: 2013-03-03 Impact factor: 3.445