Management of the Clinically Negative Lateral Neck in Medullary Thyroid Cancer

  • Raymon H. GroganEmail author
Part of the Difficult Decisions in Surgery: An Evidence-Based Approach book series (DDSURGERY)


Medullary thyroid cancer is relatively rare and accounts for approximately 2% of all thyroid cancer diagnoses in the United States. However, in general it is a more aggressive cancer than the more common papillary thyroid cancer. The more aggressive nature of medullary thyroid cancer leads to a different treatment algorithm relative to papillary thyroid cancer. The primary treatment for medullary thyroid cancer is total thyroidectomy with central neck dissection. This is almost universally accepted as standard of care across the world with minimal controversy. However, significant controversy remains regarding the optimal algorithm for surgical management of the lateral neck lymph nodes. This chapter reviews the most recent evidence regarding how to manage the lateral neck lymph nodes in medullary thyroid cancer.


Medullary thyroid cancer Lateral neck lymph node dissection Clinically negative lateral neck Lymph node metastasis Prophylactic lateral neck dissection 


  1. 1.
    Wells SA, Asa SL, Dralle H, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015;25:567–610. Scholar
  2. 2.
    Machens A, Ukkat J, Hauptmann S, Dralle H. Abnormal carcinoembryonic antigen levels and medullary thyroid cancer progression: a multivariate analysis. Arch Surg. 2007;142:289–93.; discussion 294. Scholar
  3. 3.
    Randle RW, Balentine CJ, Leverson GE, et al. Trends in the presentation, treatment, and survival of patients with medullary thyroid cancer over the past 30 years. Surgery. 2017;161:137–46. Scholar
  4. 4.
    Torresan F, Cavedon E, Mian C, Iacobone M. Long-term outcome after surgery for medullary thyroid carcinoma: a single-center experience. World J Surg. 2018;42:367–75. Scholar
  5. 5.
    Adam MA, Thomas S, Roman SA, et al. Rethinking the current American Joint Committee on cancer TNM staging system for medullary thyroid cancer. JAMA Surg. 2017;152:869–76. Scholar
  6. 6.
    Modigliani E, Cohen R, Campos JM, et al. Prognostic factors for survival and for biochemical cure in medullary thyroid carcinoma: results in 899 patients. The GETC Study Group. Groupe d’étude des tumeurs à calcitonine. Clin Endocrinol. 1998;48:265–73.CrossRefGoogle Scholar
  7. 7.
    Siironen P, Hagström J, Mäenpää HO, et al. Lymph node metastases and elevated postoperative calcitonin: predictors of poor survival in medullary thyroid carcinoma. Acta Oncol. 2016;55:357–64. Scholar
  8. 8.
    Machens A, Dralle H. Biomarker-based risk stratification for previously untreated medullary thyroid cancer. J Clin Endocrinol Metab. 2010;95:2655–63. Scholar
  9. 9.
    Machens A, Hauptmann S, Dralle H. Prediction of lateral lymph node metastases in medullary thyroid cancer. Br J Surg. 2008;95:586–91. Scholar
  10. 10.
    Leggett MD, Chen SL, Schneider PD, Martinez SR. Prognostic value of lymph node yield and metastatic lymph node ratio in medullary thyroid carcinoma. Ann Surg Oncol. 2008;15:2493–9. Scholar
  11. 11.
    Machens A, Dralle H. Prognostic impact of N staging in 715 medullary thyroid cancer patients: proposal for a revised staging system. Ann Surg. 2013;257:323–9. Scholar
  12. 12.
    Polistena A, Monacelli M, Lucchini R, et al. Surgical morbidity of cervical lymphadenectomy for thyroid cancer: a retrospective cohort study over 25 years. Int J Surg. 2015;21:128–34. Scholar
  13. 13.
    Glenn JA, Yen TWF, Fareau GG, et al. Institutional experience with lateral neck dissections for thyroid cancer. Surgery. 2015;158:972–8.; discussion 978. Scholar
  14. 14.
    Gane EM, McPhail SM, Hatton AL, et al. The relationship between physical impairments, quality of life and disability of the neck and upper limb in patients following neck dissection. J Cancer Surviv. 2018;

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Chief of Endocrine Surgery, Baylor St. Lukes Medical Center, Michael E. DeBakey Department of SurgeryBaylor College of MedicineHoustonUSA

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