SURGICAL-MANAGEMENT AND FOLLOW-UP OF MEDULLARY-THYROID CARCINOMA

Between 1977 and 1990 we operated on 33 patients with medullary thyroi d carcinoma. We performed total thyroidectomy in 31 patients and centr al node dissection and/or lateral modified node dissection in 21 patie nts (63.3%). Two patients underwent radiotherapy after subtotal resect ion and tracheostomy. No perioperative death occurred. Twenty-five pat ients were followed (mean follow-up, 63.8 months) and 8 others were un available for follow-up. Three patients (1 with multiple endocrine neo plasia type IIB, 2 sporadic with distant metastases) died of their dis ease at 12, 18 and 36 months after initial operation. Of the remaining 22 patients, 4 with stage II disease were normocalcitoninemic even wi th pentagastrin stimulation, following total thyroidectomy and bilater al modified neck dissection and central node dissection. Eighteen othe r patients continued to have elevated calcitonin levels postoperativel y. Only 10 patients with known cervical metastatic disease were reoper ated upon. We performed extensive node dissection in ah. In addition w e resected recurrent tumor from the thyroid bed in 4 patients. Despite these extensive reoperations no patient became normocalcitoninemic. A t the completion of the study (December 1991), 22 of the 25 patients f ollowed were alive: 4 patients with normal calcitonin levels, baseline and after pentagastrin stimulation, and 18 with persistent mildly ele vated calcitonin levels but no other evidence of disease. Our experien ce supports a very aggressive surgical approach at the time of the fir st operation for patients with medullary thyroid carcinoma. A lesser o peration usually resulted in residual medullary thyroid carcinoma in t he neck. We demonstrate the difficulty of achieving a cure by reoperat ion once the tumor becomes demonstrable by localization studies. (C) 1 995 Wiley-Liss, Inc.