Survival in patients with medullary thyroid cancer after less than the recommended initial operation

Background and Objectives

We aimed to evaluate the disease specific-survival (DSS) of patients with Medullary Thyroid Cancer (MTC) confined to the central neck based on the extent of the initial operation.

Methods

This retrospective review of patients with MTC from the SEER registry from 2004 to 2012 excluded patients with lateral neck involvement or distant metastases.

Results

The cohort (n = 766) included 85(11%) less than total thyroidectomies (TT), 212(28%) TT alone, and 469(61%) TT with lymph node excision. Mean tumor size was similar (2.2cm for <TT, 1.9 for TT alone, and 2.2 for TT with nodes, p=0.13). Patients receiving a TT with nodal excision were more likely to have multifocal tumors (8% <TT, 22% TT alone, and 27% TT with nodes, P < 0.001), and extrathyroidal extension (1% <TT, 4% TT alone, and 9% TT with nodes, P = 0.005). Even after controlling for significant predictors of DSS, extent of the initial operation did not predict survival (HR 0.28 for <TT, 95% CI 0.26-3.11 and HR 0.62 for TT alone, 95% CI 0.17-2.22 compared to TT with nodes, P = NS for all).

Conclusion

According to population-based SEER registry data, the extent of initial resection may not significantly change DSS in patients with MTC confined to the central neck.

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