Skip to main content
SpringerLink
Log in

Compartment-oriented microdissection of regional lymph nodes in medullary thyroid carcinoma

  • Original Articles
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Lymph node metastases have been proven to be the main prognostic factor in medullary thyroid carcinoma (MTC). This retrospective study was undertaken to evaluate the efficiency of two surgical techniques of regional lymph node dissection with regard to the normalization of pentagastrin-stimulated serum calcitonin level and patient survival: selective lymphadenectomy, i.e., the excision of macroscopically or microscopically involved lymph nodes, versus a systematic lymphadenectomy performed by the new technique of a compartment-oriented microdissection. From 1970 to 1990, 82 patients with sporadic (n=57) and hereditary (n=25) MTC underwent a total of 142 operations including 63 selective lymphadenectomies and, since 1986, 35 systematic lymphadenectomies. The study revealed that in node-positive MTC the rate of interventions with a postoperative normalization of pentagastrin-stimulated serum calcitonin was higher after systematic lymphadenectomy (29.2%) than after selective lymphadenectomy (8.5%) (P<0.01). The rate of patients undergoing repeat surgery due to a recurrence of MTC was 48% after selective lymphadenectomy and 10% after systematic lymphadenectomy. Survival was significantly better for patients after systematic versus selective lymphadenectomy (P<0.005). This study thus emphasizes that systematic lymphadenectomy, using the technique of a compartment-oriented microdissection of cervicomediastinal lymph nodes, represents the preferred surgical treatment as well as the optimum technique in primary as well as secondary node-positive MTC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Pearse AGE, Takor T (1976) Neuroendocrine embryology and the APUD concept. Clin Endocrinol 5 [Suppl.]: 2295–445

    Google Scholar 

  2. Sipple JH (1961) Reassociation of pheochromocytoma with carcinoma of the thyroid gland. Am J Med 31:163–166

    Article  Google Scholar 

  3. Williams ED, Brown CL, Doniach I (1966) Pathological and clinical findings in a series of 67 cases of medullary carcinoma of the thyroid. J Clin Pathol 19:103–113

    PubMed  CAS  Google Scholar 

  4. Woolner LB, Beahrs OH, Black BM, McConahey WM, Keating FR (1968) Thyroid carcinoma: General considerations and follow-up data on 1181 cases. In: Young ST, Imman DR (eds) Thyroid neoplasia, Academic, London, pp 51–79

    Google Scholar 

  5. Schröder S, Böcker W, Baisch H, Bürk CG, Arps H, Meiners I, Kastendieck H, Heitz PU, Klöppel G (1988) Prognostic factors in medullary thyroid carcinoma. Cancer 61:806–816.

    Article  PubMed  Google Scholar 

  6. Bigner SH, Cox EB, Mendelsohn G, Baylin SB, Wells SA, Egglestone JC (1981) Medullary carcinoma of the thyroid in the multiple endocrine neoplasia HA syndrome. Am J Surg Pathol 5:459–472

    Article  PubMed  CAS  Google Scholar 

  7. Saad MF, Guido JJ, Samaan NA (1983) Radioactive iodine in the treatment of medullary carcinoma of the thyroid. J Clin Endocrinol Metab 57:124–128

    PubMed  CAS  Google Scholar 

  8. Rougier P, Parmentier C, Laplanche A, Leferre M, Travagli JP, Caillon B, Schlumberger M, Lacour J, Tubiana M (1983) Medullary thyroid carcinoma: Prognostic factors and treatment. Int J Radiat Oncol Biol Phys 9:161–169

    PubMed  CAS  Google Scholar 

  9. Hazard JB, Hawk WA, Crile G (1959) Medullary (solid) carcinoma of the thyroid: A clinicopathologic entity. J Clin Endocrinol Metab 19:151–161

    Google Scholar 

  10. Tisell LE, Hansson G, Jansson S, Salander H (1986) Reoperation in the treatment of asymptomatic metastasizing medullary thyroid carcinoma. Surgery 99:60–66

    PubMed  CAS  Google Scholar 

  11. Brunt LM, Wells SA (1987) Advances in the diagnosis and treatment of medullary thyroid carcinoma. Surg Clin North Am 67:263–279

    PubMed  CAS  Google Scholar 

  12. Block MA (1990) Surgical treatment of medullary carcinoma of the thyroid. Otolaryngol Clin North Am 23:453–473

    PubMed  CAS  Google Scholar 

  13. Buhr HJ, Lehnet T, Raue F (1990) New operative strategy in the treatment of metastasizing medullary carcinoma of the thyroid. Eur J Surg Oncol 16:366–369

    PubMed  CAS  Google Scholar 

  14. Dralle H, Scheumann GFW, Kotzerke J, Brabant E (1992) Surgical management of MEN 2. Recent Results Cancer Res 125:167–195.

    PubMed  CAS  Google Scholar 

  15. Wells SA, Outjes DA, Cooper CW, Hennessy JF, Ellis GJ, McPherson HT, Sabiston DC (1975) The early diagnosis of medullary carcinoma of the thyroid gland in patients with multiple endocrine neoplasia type II. Ann Surg 182:362–370

    PubMed  Google Scholar 

  16. Jackson CE, Talpos GB, Kambouris A, Yott JB, Tashjian AH Block MA (1983) The clinical course after definite operation for medullary thyroid carcinoma. Surgery 94:995–1001

    PubMed  CAS  Google Scholar 

  17. Miyaushi A, Matsuzuka F, Kuma K, Takai S, Nakamoto M (1988) Evaluation of surgical results and prediction of prognosis in patients with medullary thyroid carcinoma by analysis of serum calcitonin levels. World J Surg 12:610–615

    Article  Google Scholar 

  18. Lynn J, Gamvros OI, Taylor S (1981) Medullary carcinoma of the thyroid. World I Surg 5:27–32

    Article  CAS  Google Scholar 

  19. Russell CF, van Heerden JH, Sizemore GW, Edis AJ, Taylor WF, ReMine WH, Carney JH (1983) The surgical management of medullary thyroid carcinoma. Ann Surg 197:42–48

    PubMed  CAS  Google Scholar 

  20. Noguchi S, Murakami N (1987) The value of lymph node disection in patients with differentiated thyroid cancer. Surg Clin North Am 67:251–261

    PubMed  CAS  Google Scholar 

  21. Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481

    Article  Google Scholar 

  22. Breslow N (1970) A generalized Kruskel-Wallis test for comparing K samples subjects to unequal patterns of cencorship. Biometrika 57:579–594

    Article  Google Scholar 

  23. Hedinger C, Williams ED, Sobin LH (1988) Histological typing of thyroid tumors, 2nd edn. Springer, Berlin Heidelbeg, New York, pp 11–13

    Google Scholar 

  24. Hermanek P, Scheibe O, Spiessl B, Wagner G (1987) TNM classification of malignant tumors. 4th edn. Springer, Berlin Heidelberg, New York, pp 36–38

    Google Scholar 

  25. Block MA, Miller JM, Horn RC (1968) Medullary carcinoma of the thyroid: Surgical implications. Arch Surg 96:521–526

    PubMed  CAS  Google Scholar 

  26. Block MH, Jackson CE, Tashjian AH (1978) Management of occult medullary thyroid carcinoma. Arch Surg 113:368–372

    PubMed  CAS  Google Scholar 

  27. Block MH, Jackson CE, Greenawald KA, Yott JB, Tashjian AH (1980) Clinical characteristics distinguishing hereditary from sporadic medullary thyroid carcinoma. Arch Surg 115:142–148

    PubMed  CAS  Google Scholar 

  28. Wells SA, Dilley WG, Farndon JA, Leight GS, Baylin SB (1985) Early diagnosis and treatment of medullary thyroid carcinoma. Arch Intern Med 145:1248–1252

    Article  PubMed  Google Scholar 

  29. Duh QY, Sancho JJ, Greenspan FS, Hunt TK, Galante M, De Lorimier AA, Conte FA, Clark OH (1989) Medullary thyroid carcinoma. Arch Surg 124:1206–1210

    PubMed  CAS  Google Scholar 

  30. van Heerden JA, Grant CS, Gharib H, Hay ID, Ilstrup DM (1990) Long-term course of patients with persistent hypercalcitoninemia after apparent curative primary surgery for medullary thyroid carcinoma. Ann Surg 212:395–401

    PubMed  Google Scholar 

  31. Trump DL, Mendelsohn G, Baylin HB (1979) Discordance between plasma calcitonin and tumor-cell mass in medullary thyroid carcinoma. N Engl J Med 301:253–255

    Article  PubMed  CAS  Google Scholar 

  32. Lippmann SM, Mendelsohn G., Trump DL, Wells SH, Baylin SB (1982) The prognostic and biological significance of cellular heterogeneity in medullary thyroid carcinoma: A study of calcitonin,l-dopa decarboxylase, and histaminase. J Clin Endocrinol Metab 54:233–40.

    Article  Google Scholar 

  33. Busnardo B, Girelli ME, Simioni N, Nacamulli D, Busetto E (1984) Non-parallel patterns of calcitonin and carcinoembryonic antigen levels in the follow-up of medullary thyroid carcinoma. Cancer 53:278–285

    Article  PubMed  CAS  Google Scholar 

  34. Dralle H, Schwarzrock R, Lang W, Böcker W, Ziegler H, Schröder S, Geerlings H (1985) Comparison of histology and immunohistochemistry with thyroglobulin serum levels and radioiodine uptake in recurrences and metastases of differentiated thyroid carcinoma. Acta Endocrinol 108:504–510

    PubMed  CAS  Google Scholar 

  35. Dralle H, Böcker W, Döhler KD, Schröder S, Haindl H, Geerlings H, Schwarzrock R, Pichlmayr R (1985) Growth and function of 34 human benign and malignant thyroid xenografts in untreated nude mice. Cancer Res 45:1239–1245

    PubMed  CAS  Google Scholar 

  36. Norton JA, Doppman JL, Brennan MF (1980) Localization and resection of clinically inapparent medullary carcinoma of the thyroid. Surgery 87:616–622

    PubMed  CAS  Google Scholar 

  37. Troncone L, Rufini V, De Rosa G, Testa A (1989) Diagnostic and therapeutic potential of new radiopharmaceutical agents in medullary thyroid carcinoma. Henry Ford Hosp Med J 37: 178–184

    PubMed  CAS  Google Scholar 

  38. Russell WO, Ibanez ML, Clark RI, White EC (1963) Thyroid carcinoma, classification, intraglandular dissemination, and clinicopathological study based upon whole organ sections of 80 glands. Cancer 16:1425–1460

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover, Konstanty-Gutschow-Str. 8, 30625, Hannover, Germany

    Henning Dralle, Iris Damm, Georg Friedrich Wilhelm Scheumann & Rudolf Pichlmayr

  2. Abteilung Nuklearmedizin und Klinische Biophysik, Medizinische Hochschule Hannover, Konstanty-Gutschow-Str. 8, 30625, Hannover, Germany

    Jörg Kotzerke

  3. Institut für Pathologie, Medizinische Hochschule Hannover, Konstanty-Gutschow-Str. 8, 30625, Hannover, Germany

    Eckart Kupsch

  4. Abteilung Biometrie, Medizinische Hochschule Hannover, Konstanty-Gutschow-Str. 8, 30625, Hannover, Germany

    Heinz Geerlings

Authors
  1. Henning Dralle
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Iris Damm
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Georg Friedrich Wilhelm Scheumann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jörg Kotzerke
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eckart Kupsch
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Heinz Geerlings
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Rudolf Pichlmayr
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Dralle, H., Damm, I., Wilhelm Scheumann, G.F. et al. Compartment-oriented microdissection of regional lymph nodes in medullary thyroid carcinoma. Surg Today 24, 112–121 (1994). https://doi.org/10.1007/BF02473391

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02473391

Key Words

Search

Navigation