Role of lateral limphodissection in the radical treatment of medullar thyroid carcinoma

Abstract

In order to determine the need for prophylactic lateral cervical lymph node dissection in patients with medullary thyroid carcinoma with tumors of various size, a retrospective analysis has been conducted, of the incidence of recurrences and mortality of patients depending on tumor size and volume of surgery. The study confirmed the idea dominating in the literature, of a mandatory extrafascial thyroidectomy even for tumors less than 2 cm. In case of thyroidectomy and lateral (unilateral or bilateral) lymph node dissection, the frequency of recurrences and mortality of patients was very high, due to frequent tumor metastases primarily to the lymph nodes of the central compartment of the neck. The recurrence and mortality rates among patients after an isolated central dissection is low, and all cases of complications or death concerned exclusively patients with tumors larger than 2 cm. In case of thyroidectomy followed by a combined
central and lateral lymph node dissection, a small amount of recurrences and death were also reported in patients: they were significantly lower compared with the group of patients who underwent thyroidectomy and lateral neck dissection, and were comparable with the group of patients who underwent central cervical lymph node dissection. This is most evident for the group of patients with tumors up to 2 cm. Based on this analysis, the authors conclude that in case
of medullary carcinomas larger than 2 cm, even in the absence of lymph node metastases (from a survey of methods of topical diagnosis), it is appropriate to perform - in conjunction with thyroidectomy and central lymph dissection - a bilateral lymphadenectomy as well.