Rebecca S. Sippel, MD, from the University of Wisconsin, discusses the importance of the initial surgery for patients with medullary thyroid cancer on outcomes.
Rebecca S. Sippel, MD, associate professor of surgery, University of Wisconsin, Madison, Wisconsin, discusses the importance of the initial surgical procedure for the management of patients with medullary thyroid cancer (MTC).
The initial surgery for MTC substantially dictates and impacts the long-term prognosis for patients. The most adequate and successful surgery requires proper preoperative diagnosis and planning, Sippel believes. Following a diagnosis by fine-needle aspiration cytology, an appropriate staging evaluation using calcitonin levels and a neck ultrasound establishes whether the disease is regional or metastatic and helps determine the extent of the surgery.
Sippel recommends a total thyroidectomy plus a comprehensive bilateral central neck dissection (CND) for every patient with MTC, at the first surgical intervention. She warns that a bilateral CND is difficult to perform in a second procedure, warranting the upfront use in every patient since nodal disease is common. However, in some cases, a lateral or ipsilateral lateral neck dissection may also be effective, she adds.
Unlike other types of thyroid cancer, surgical management is the mainstay for MTC and must be aggressive and comprehensive at the initial operation in order to achieve the best results.