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Fewer Cancer Reoperations for Medullary Thyroid Cancer After Initial Surgery According to ATA Guidelines

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Surgery is still the only curative treatment for medullary thyroid cancer (MTC). We evaluated clinical outcome in patients with locoregional MTC with regard to adequacy of treatment following ATA guidelines and number of sessions to first intended curative surgery in different hospitals.

Methods

We reviewed all records of MTC patients (n = 184) treated between 1980 and 2010 in two tertiary referral centers in the Netherlands. Symptomatic MTC (palpable tumor or suspicious lymphadenopathy) patients without distant metastasis were included (n = 86). Patients were compared with regard to adequacy of surgery according to ATA recommendations, tumor characteristics, number of local cancer reoperations, biochemical cure, clinical disease-free survival (DFS), overall survival (OS), and complications.

Results

Adherence to ATA guidelines resulted in fewer cancer-related reoperations (0.24 vs. 0.60; P = 0.027) and more biochemical cure (40.9 vs. 20 %; P = 0.038). Surgery according to ATA-guidelines on patients treated in referral centers was significantly more often adequate (59.2 vs. 26.7 %; P = 0.026). Tumor size and LN+ were the most important predictors for clinical recurrence [relative risk (RR) 4.1 (size > 40 mm) 4.1 (LN+) and death (RR 4.2 (size > 40 mm) 8.1 (LN+)].

Conclusions

ATA-compliant surgery resulted in fewer local reoperations and more biochemical cure. Patients in referral centers more often underwent adequate surgery according to ATA-guidelines. Size and LN+ were the most important predictors for DFS and OS.

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Authors and Affiliations

  1. Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands

    Hans H. G. Verbeek MD, Wim J. Sluiter PhD & Thera P. Links MD, PhD

  2. Department of Endocrinology, Leiden University Medical Center, Leiden, The Netherlands

    Johannes A. A. Meijer MD, Wouter T. Zandee MD & Johannes W. Smit MD, PhD

  3. Department of Internal Medicine, Albert Schweitzer Hospital, Dordrecht, The Netherlands

    Johannes A. A. Meijer MD

  4. Department of Surgical Oncology, University Medical Center Groningen, Groningen, The Netherlands

    Kelvin H. Kramp BSc & John Th. M. Plukker MD, PhD

  5. Department of Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands

    Johannes W. Smit MD, PhD

  6. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands

    Job Kievit MD, PhD

Authors
  1. Hans H. G. Verbeek MD
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  2. Johannes A. A. Meijer MD
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  3. Wouter T. Zandee MD
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  4. Kelvin H. Kramp BSc
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  5. Wim J. Sluiter PhD
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  6. Johannes W. Smit MD, PhD
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  7. Job Kievit MD, PhD
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  8. Thera P. Links MD, PhD
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  9. John Th. M. Plukker MD, PhD
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Corresponding author

Correspondence to John Th. M. Plukker MD, PhD.

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Verbeek, H.H.G., Meijer, J.A.A., Zandee, W.T. et al. Fewer Cancer Reoperations for Medullary Thyroid Cancer After Initial Surgery According to ATA Guidelines. Ann Surg Oncol 22, 1207–1213 (2015). https://doi.org/10.1245/s10434-014-4115-6

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  • DOI: https://doi.org/10.1245/s10434-014-4115-6

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