Surgical strategies in patients with medullary thyroid carcinoma
di
S. Sorrenti, E. Guaitoli, A. Catania, V. D’Andrea, F. M.Di Matteo, M. Nardi, N. Prinzi, F. Nardi, V. Ascoli, E. Baldini, S. Ulisse, E. De Antoni
Objectives. 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). Materials and 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. Clin Ter 2012; 163(5):e303-306
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