Locoregional control in patients with palpable medullary thyroid cancer: results of standardized compartment-oriented surgery.

Background: Extent of neck dissection is controversial in patients with palpable medullary thyroid cancer (MTC).

Methods: We evaluated 64 MTC patients (19 hereditary, 45 sporadic) with palpable thyroid nodules (group 1, n = 35) or palpable lymph node metastases (group 2, n = 29). Standard surgery included total thyroidectomy, central compartment dissection, and additional neck dissection on indication.

Results: In group 1, 40% of the patients were cured. Thirty-one percent of all patients had central, 23% ipsilateral, 14% contralateral, and 14% mediastinal, metastases. Fifty-one percent developed locoregional recurrence. Locoregional recurrence (p = .043) and reoperations (p = .020) were noted more often after a less than standard initial procedure. In group 2, no patients were cured. All had central, 93% ipsilateral, 45% contralateral, and 52% mediastinal metastases. Thirty-eight percent developed locoregional recurrence.

Conclusions: Locoregional recurrence frequently occurs in palpable MTC, and tumor control may be improved by standard central, bilateral, and upper mediastinal neck dissection.