Surgical strategy for the treatment of sporadic medullary thyroid carcinoma: our experience

Background. Medullary thyroid carcinoma (MTC) is a rare disease which accounts for approximately 5-9% of all thyroid cancers and originates from the calcitonin-secerning parafollicular C cells. MTC can be divided into two subgroups: sporadic (75%) or inherited (25%). The majority of patients with invasive MTC have metastasis to regional lymph nodes at the time of diagnosis, as evidenced by the frequent finding of persistently elevated calcitonin levels after thyroidectomy and the high rates of recurrence in the cervical lymph nodes reported in retrospective studies. Objectives. The purpose of the study is to review our single institution's experience with MTC since 1998 and to evaluate surgical strategy, patterns of lymph node metastases and calcitonin response to compartment-oriented lymphadenectomy in patients with primary or recurrent sporadic medullary thyroid carcinoma. Methods. A retrospective review of 26 patients treated for MTC at the “Antonio Cardarelli” Hospital referral center, in Naples, between 1998 and 2012. There were 18 female and 8 male patients, median age at presentation was 55 years, and median follow-up for survivors was 5 years. Total thyroidectomy was performed in all 26 patients; central compartment (CC) node dissection (level VI) in 12 (46%) patients; central plus lateral compartment (LC) node dissection (levels II, III, and IV) in 7 (27%) patients. 4 patients (15%) underwent reoperation for loco-regional recurrent/persistent MTC. Results. After a median post-surgical follow-up of 5 years (range 1-10 years), 63 % of patients were living disease-free, 15% were living with disease and/or persistently elevated calcitonin levels after surgery, 11% were deceased due to MTC and 11 % were lost to follow-up. Conclusions. We agree with most authors advocating for a total thyroidectomy and prophylactic central neck dissection in the setting of clinically detected MTC. Lateral neck dissection may be best reserved for patients with positive preoperative imaging. Nevertheless MTC has a high rate of lymph node metastases that are sub optimally detected preoperatively in the central compartment by neck ultrasound or intra-operatively by the surgeon, and reoperation is associated with a higher rate of surgical complications. In our limited experience, patients with thyroid confined nodular pathology, without nodal disease and unknown preoperative diagnosis of MTC, underwent only total thyroidectomy with a good prognosis.

Reviews pages: Extreme weather events caused by climate change

Starting from the relationship between urban planning and mobility management, TeMA has gradually expanded the view of the covered topics, always remaining in the groove of rigorous scientific in-depth analysis. During the last two years a particular attention has been paid on the Smart Cities theme and on the different meanings that come with it. The last section of the journal is formed by the Review Pages. They have different aims: to inform on the problems, trends and evolutionary processes; to investigate on the paths by highlighting the advanced relationships among apparently distant disciplinary fields; to explore the interaction’s areas, experiences and potential applications; to underline interactions, disciplinary developments but also, if present, defeats and setbacks. Inside the journal the Review Pages have the task of stimulating as much as possible the circulation of ideas and the discovery of new points of view. For this reason the section is founded on a series of basic’s references, required for the identification of new and more advanced interactions. These references are the research, the planning acts, the actions and the applications, analysed and investigated both for their ability to give a systematic response to questions concerning the urban and territorial planning, and for their attention to aspects such as the environmental sustainability and the innovation in the practices. For this purpose the Review Pages are formed by five sections (Web Resources; Books; Laws; Urban Practices; News and Events), each of which examines a specific aspect of the broader information storage of interest for TeMA.

Review Pages: Planning for Livable and Safe Cities: Energy, Pollution and the Degradation of the Urban Environment

Starting from the relationship between urban planning and mobility management, TeMA has gradually expanded the view of the covered topics, always remaining in the groove of rigorous scientific in-depth analysis. During the last two years a particular attention has been paid on the Smart Cities theme and on the different meanings that come with it. The last section of the journal is formed by the Review Pages. They have different aims: to inform on the problems, trends and evolutionary processes; to investigate on the paths by highlighting the advanced relationships among apparently distant disciplinary fields; to explore the interaction’s areas, experiences and potential applications; to underline interactions, disciplinary developments but also, if present, defeats and setbacks. Inside the journal the Review Pages have the task of stimulating as much as possible the circulation of ideas and the discovery of new points of view. For this reason the section is founded on a series of basic’s references, required for the identification of new and more advanced interactions. These references are the research, the planning acts, the actions and the applications, analysed and investigated both for their ability to give a systematic response to questions concerning the urban and territorial planning, and for their attention to aspects such as the environmental sustainability and the innovation in the practices. For this purpose the Review Pages are formed by five sections (Web Resources; Books; Laws; Urban Practices; News and Events), each of which examines a specific aspect of the broader information storage of interest for TeMA.