Surgical Strategies and Methods for the Treatment of Metastasizing Medullary Thyroid Carcinoma
The medullary thyroid carcinoma (MTC) exhibits several biological peculiarities. The early formation of metastases in the local lymph nodes of the neck region and of the proximal mediastinum is of particular importance for the development of therapeutic regimens (Bergholm et al. 1989; Buhr et al. 1991; Duh et al. 1989; Graze et al. 1978). Considering patients with elevated basal calcitonin values which were detected during family screening programs Wells et al. (1978b) demonstrated in 50% a lymph node involvement. Patients with clinically manifest tumors suffered in 71% from local metastases. Similarly, metastases in the neck lymph nodes were found in 9% and mediastinal secondaries in 8% of patients with clinically occult familial C-cell carcinomas characterized by normal basal calcitonin levels but pathological elevations upon pentagastrin stimulation. The prognostic relevance of lymph node metastases is demonstrated by the classic work of Woolner et al. (1969). The 10-year survival rate of patients without lymph node involvement reached 85% and was not significantly different to a reference population. In patients with lymph node involvement it was significantly reduced to 42%. These reports were further substantiated by other authors (Bergholm et al. 1989; Roka et al. 1982; Saad et al. 1984; Schröder et al. 1988; Wahl et al. 1987). Since distant metastases occur only late in the natural history of the disease, surgical eradication of lymph node metastases can prolong the patient’s life and even achieve higher cure rates (Tisell et al. 1986). Since the tumor cells are relatively radio- and chemoresistant, surgical intervention is highly indicated (Pertursson 1988; Samaan et al. 1988; Scherübl et al. 1990).
KeywordsNeck Dissection Total Thyroidectomy Internal Jugular Vein Medullary Thyroid Carcinoma Medullary Thyroid Cancer
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