BACKGROUND

Medullary thyroid cancer is a rare type of thyroid cancer that often runs in families. The main treatment of medullary thyroid cancer is surgery. Unlike the more common papillary thyroid cancer, radioactive iodine plays no role in the treatment of medullary thyroid cancer. At minimum, the recommended initial operation for patients with medullary thyroid cancer includes surgery to remove the entire thyroid gland (thyroidectomy) and removal of the lymph nodes in the central neck (central neck dissection). However, many patients continue to have less involved initial surgeries. Current guidelines differ on how best to approach a patient with less than the recommended initial operation. The goal of this study was to evaluate the survival of patients with medullary thyroid cancer with localized cancer based on the extent of the initial operation.

THE FULL ARTICLE TITLE:

Randle RW et al 2018 Survival in patients with medullary thyroid cancer after less than the recommended initial operation. J Surg Oncol 117:1211–1216. Epub 2017 Dec 19. PMID: 29266278.

SUMMARY OF THE STUDY

This was a study of patients with medullary thyroid cancer diagnosed between 2004 and 2012 using the Surveillance, Epidemiology, and End Results (SEER) registry. Patients with cancer limited to only the central neck area were included. Patients younger than 18 years of age were not included. Patients with cancer that has spread to the lymph nodes on the side of the neck or that has spread from the initial site to other parts of the body also were not included. Patients included in this study were compared based on the extent of their first operation as recorded in SEER: less than a total thyroidectomy, total thyroidectomy, and total thyroidectomy with removal of lymph nodes.

A total of 766 patients with medullary thyroid cancer were included. A total of 85 patients (11%) had less than a total thyroidectomy, 212 (28%) had a thyroidectomy alone, and 469 (61%) had a total thyroidectomy with removal of lymph nodes. Despite differences in the extent of the initial surgery, survival was similar among the groups. The 5-year disease specific survival (percentage of people in a group who have not died from their cancer five years after diagnosis) was 98.8% in the less than total thyroidectomy group, 98.1% in the total thyroidectomy group, and 97.3% in the total thyroidectomy with lymph node removal group.

WHAT ARE THE IMPLICATIONS OF THIS STUDY?

This study showed that according to the SEER registry, the extent of the initial surgery may not significantly change survival in patients with medullary thyroid cancer limited to the central neck. Total thyroidectomy and surgery of the central neck lymph nodes remains the most appropriate initial surgery. However, this study suggests that patients with medullary thyroid cancer that does not have a genetic component and does not run in families with no residual cancer may not need more surgery after less extensive initial operations.

— Priya Mahajan, MD

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