SURGICAL-MANAGEMENT OF PATIENTS WITH PERSISTENT OR RECURRENT MEDULLARY-THYROID CANCER

Residual or recurrent medullary thyroid carcinoma (MTC), manifested by elevated calcitonin levels, occurs commonly following primary treatme nt of MTC, Reoperation in appropriately selected patients is the only treatment modality which consistently and reliably reduces stimulated calcitonin levels, and results in excellent local disease control. We report improved results of surgical management of recurrent MTC in two consecutive series of patients. In our most recent series (1992-96), 38% of patients (17 out of 45) had normal postoperative stimulated cal citonin levels, compared to 28% (nine of 32) in our first series (1990 -92). In the most recent series, only 13% (six of 45) of patients had no decrease in calcitonin levels following re-operation, compared to 3 1% (10 of 32) in our first series (P = 0.07, Fisher's exact test). Thi s improvement has mainly occurred through better preoperative selectio n of patients, and the institution of routine laparoscopic liver exami nation preoperatively, which identified metastases in 10 patients, nin e of whom had normal CT or MRI imaging.