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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 4/2015

01-04-2015 | Endocrine Tumors

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

Authors: Hans H. G. Verbeek, MD, Johannes A. A. Meijer, MD, Wouter T. Zandee, MD, Kelvin H. Kramp, BSc, Wim J. Sluiter, PhD, Johannes W. Smit, MD, PhD, Job Kievit, MD, PhD, Thera P. Links, MD, PhD, John Th. M. Plukker, MD, PhD

Published in: Annals of Surgical Oncology | Issue 4/2015

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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.
Appendix
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Metadata
Title
Fewer Cancer Reoperations for Medullary Thyroid Cancer After Initial Surgery According to ATA Guidelines
Authors
Hans H. G. Verbeek, MD
Johannes A. A. Meijer, MD
Wouter T. Zandee, MD
Kelvin H. Kramp, BSc
Wim J. Sluiter, PhD
Johannes W. Smit, MD, PhD
Job Kievit, MD, PhD
Thera P. Links, MD, PhD
John Th. M. Plukker, MD, PhD
Publication date
01-04-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 4/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-4115-6

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