Long-term results of reoperation and localizing studies in patients with persistent or recurrent medullary thyroid cancer

Hypothesis: Reoperation benefits patients with locoregional, persistent, or recurrent medullary thyroid cancer (MTC). Currently available localizing s tudies have limited utility for detecting all foci of residual MTC. Design: A retrospective study with a mean follow-up time of 7.5 years (medi an, 13 years: range, 2.2-29 years). Setting: A tertiary referral medical center. Patients: Thirty-three patients who underwent 46 reoperations for locoregio nal residual MTC. Results: Sixty-four percent of residual MTC was located in the lateral cerv ical nodes, 22% in the central cervical nodes or thyroid bed, and 14% in th e 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 n ot reduced by greater than 50% in the remaining patients. On reoperation, o ne patient had a thoracic duct injury that required reexploration and ligat ion. Patients who had a greater than 50% decrease in calcitonin levels afte r reoperation were less likely to develop distant metastases compared with patients who did not have a greater than 50%;7 decrease (P<.05). The sensit ivities 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 resu lts in biochemical cure, cervical reexploration is safe and in selected pat ients may limit MTC progression. Lateral cervical node dissection could be beneficial at the time of initial surgical treatment because of the high fr equency 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.