Endocrine
https://doi.org/10.1007/s12020-018-1625-1
ENDOCRINE SURGERY
Histology-proven recurrence in the lateral or central neck after
systematic neck dissection for medullary thyroid cancer
Andreas Machens
1
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Kerstin Lorenz
1
●
Henning Dralle
1,2
Received: 20 March 2018 / Accepted: 4 May 2018
© Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract
Purpose To delineate risk factors for, and examine temporal patterns of, histology-proven recurrent medullary thyroid
cancer (MTC) after compartment-oriented surgery.
Methods Multivariate Cox regression on overall, node, and soft tissue infiltrate recurrence per previously dissected neck
compartment.
Results Mean follow-up for the 203 (and 158) patients with central (and ipsilateral lateral) neck dissection was 56.1 months.
On multivariate Cox regression, tumor size > 20 mm predicted overall and node recurrence in the central neck, whereas
extranodal growth predicted overall and node recurrence in the ipsilateral lateral neck. Extrathyroidal extension alone
predicted soft tissue infiltrate recurrence in the central neck, and extranodal growth alone soft tissue infiltrate recurrence in
the ipsilateral lateral neck. When analyses were restricted to patients not biochemically cured after initial surgery, only
extranodal growth predicted overall and node recurrence in the dissected neck compartments.
Conclusions Patients not biochemically cured, specifically those with extranodal growth at the initial operation, carry greater
risks of node recurrence.
Keywords Medullary thyroid carcinoma
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Lymph node metastasis
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Compartment-oriented neck dissection
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Node recurrence
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Soft tissue infiltrate recurrence
Introduction
Medullary thyroid cancer (MTC), a calcitonin-secreting
neuroendocrine malignancy, has been notorious for its
propensity to spread early beyond the thyroid capsule [1].
The appreciation that adequate surgery for MTC reduced
tumor recurrence from 34% overall to 23% [1] prompted
Lars Tisell in the early 1980s to embark on meticulous neck
dissection for clearance of residual disease [2]. This
approach ultimately evolved into the current concept of
compartment-oriented microdissection as initial therapy [3].
Node metastases from MTC favor the central and the
ipsilateral lateral neck, whereas involvement of the con-
tralateral lateral neck or the upper anterior mediastinum is
less common [4, 5]. Even patients with MTC as small as
5 mm may harbor neck node metastases [6]. If not surgi-
cally cleared, these node metastases continue to secrete
calcitonin into the bloodstream, heralding persistent disease.
In a scarred neck, the ability to reliably identify and
pinpoint recurrent MTC early on hinges on the use of
advanced imaging technology: 2-[Fluorine-18]fluoro-2-
deoxy-
D
-glucose (FDG) and 18F-dihydroxyphenylalanine
(F-DOPA) positron emission tomography (PET) without
[7–10] or with simultaneous computed tomography (CT)
[11–14]. A positive scan does not always indicate structural
disease, in particular when the tumor load is low. Without
reoperation, the frequency of residual disease in the central
and lateral neck remains unknown.
Unlike death, locoregional tumor recurrence—and much
less its ramifications on the patient’s health-related quality
of life—is not readily determined, not easily quantified, and
less concrete [15]. Many tumor registries, including the
population-based surveillance, epidemiology, and end
results (SEER) data base, lack reliable documentation of
* Andreas Machens
AndreasMachens@aol.com
1
Department of General, Visceral and Vascular Surgery, Medical
Faculty, Martin Luther University Halle-Wittenberg, Ernst-Grube-
Strasse 40, D-06097 Halle (Saale), Germany
2
Department of General, Visceral and Transplantation Surgery,
Section of Endocrine Surgery, University of Duisburg-Essen,
Essen, Germany
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