Management of the lateral neck compartment in patients with sporadic medullary thyroid cancer

• Published in: Head & neck 2018-01, Vol.40 (1), p.79-85
• Main Authors: Pena, Israel, Clayman, Gary L., Grubbs, Elizabeth G., Bergeron, Jeffrey M., Waguespack, Steven G., Cabanillas, Maria E., Dadu, Ramona, Hu, Mimi I., Fellman, Bryan M., Li, Yisheng, Gross, Neil D., Lai, Stephen Y., Sturgis, Erich M., Zafereo, Mark E.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; American Thyroid Association; calcitonin; Carcinoma, Neuroendocrine - diagnostic imaging; Carcinoma, Neuroendocrine - mortality; Carcinoma, Neuroendocrine - pathology; Carcinoma, Neuroendocrine - surgery; Cause of Death; Cohort Studies; Disease control; Disease Management; Disease-Free Survival; elective neck dissection; Elective Surgical Procedures - methods; Elective Surgical Procedures - mortality; Female; Head and neck; Humans; Kaplan-Meier Estimate; Male; Metastases; Metastasis; Middle Aged; Neck; Neck Dissection - methods; Neck Dissection - mortality; Neoplasm Invasiveness; Neoplasm Staging; observation; Prognosis; regional metastases; Retrospective Studies; Risk Assessment; Statistics, Nonparametric; Surgery; Survival Analysis; Thyroid cancer; Thyroid Neoplasms - diagnostic imaging; Thyroid Neoplasms - mortality; Thyroid Neoplasms - pathology; Thyroid Neoplasms - surgery; Thyroidectomy - methods; Tomography, X-Ray Computed - methods; Watchful Waiting
• ISSN: 1043-3074; 1097-0347
• DOI: 10.1002/hed.24969

Background The purpose of this retrospective analysis was to evaluate the benefits of an elective lateral neck dissection (ELND) in patients with medullary thyroid cancer (MTC) without radiographically apparent lateral neck metastases. Methods Patients with sporadic MTC without radiographic evidence of lateral neck metastasis who underwent definitive surgery were divided into 2 groups based on surgical approach: no ELND (the observation group) and ipsilateral or bilateral ELND (the ELND group). Primary outcomes were biochemical cure, locoregional recurrence, distant metastasis, and overall survival (OS). Results Sixty‐six patients met inclusion criteria: 44 patients (67%) in the observation group and 22 patients (33%) in the ELND group. Two of 44 patients (5%) in the observation group developed subsequent (ipsilateral) lateral neck disease. At last follow‐up, locoregional disease control rates among the observation and ELND groups were 98% and 100% (P > .999), respectively, whereas biochemical cure rates were 82% and 85% (P > .999), respectively, and 5‐year OSs were 84% and 100% (P = .156), respectively. Conclusion Patients with MTC without lateral neck metastasis have similar biochemical cure rates with observation or elective dissection of lateral neck compartments.