Timing and extension of lymphadenectomy in medullary thyroid carcinoma: A case series from a single institution

Background Medullary thyroid carcinoma is an aggressive tumor and presents with significant morbidity and mortality and a high rate of lymph node metastases. The combination of total thyroidectomy and cervical lymphadenectomy is the essential treatment for those patients presenting with cervical lymph node metastases. Materials and methods A retrospective analysis of 117 patients operated for medullary thyroid carcinoma over a period of 15 years at a single institution. Surgical complications and calcitonin levels were noted. Results Nodal metastases were detected in the central compartment in 72.6% patients. Positive lymph nodes were detected in the lateral compartment of 34 patients who had undergone ipsilateral dissection and in all 10 patients of those with bilateral surgery. We found 3 cases of unilateral transient recurrent laryngeal nerve palsy, 15 cases of temporary hypoparathyroidism, a permanent accessory nerve lesion and a case of chylous fistula. Normalization of post-operative calcitonin was found in 82.6% and of patients who underwent total thyroidectomy and central neck dissection alone compared to 35.4% in those with ipsilateral and bilateral neck dissection. Conclusions Total thyroidectomy and cervical lymphadenectomy planned on the ultrasound preoperative study and on the calcitonin level represent the standard of treatment for medullary thyroid carcinoma.