Omission of lateral lymph node dissection in medullary thyroid cancer without a desmoplastic stromal reaction.

Autor:	Niederle MB; Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.; Department of General Anaesthesia, General Intensive Care and Pain Management, Medical University of Vienna, Vienna, Austria., Riss P; Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria., Selberherr A; Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria., Koperek O; Labor Kaserer, Koperek & Beer, Pathology, Medical University of Vienna, Vienna, Austria.; Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria., Kaserer K; Labor Kaserer, Koperek & Beer, Pathology, Medical University of Vienna, Vienna, Austria.; Clinical Institute of Pathology, Medical University of Vienna, Vienna, Austria., Niederle B; Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.; Former Head of Endocrine Surgery Section, Department of Surgery, Medical University of Vienna, Vienna, Austria., Scheuba C; Division of General Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria.
Jazyk:	angličtina
Zdroj:	The British journal of surgery [Br J Surg] 2021 Mar 12; Vol. 108 (2), pp. 174-181.
DOI:	10.1093/bjs/znaa047
Abstrakt:	Background: Medullary thyroid cancer can be subdivided during surgery into tumours with or without a desmoplastic stromal reaction (DSR). DSR positivity is regarded as a sign of disposition to metastasize. The aim of this study was to analyse whether lateral lymph node dissection can be omitted in patients with DSR-negative tumours. Methods: This was a retrospective cohort study of a prospectively maintained database of patients with medullary thyroid cancer treated using a standardized protocol, and subdivided into DSR-negative and -positive groups based on the results of intraoperative frozen-section analysis. Patients in the DSR-negative group did not undergo lateral lymph node dissection. Long-term clinical and biochemical follow-up data were collected, and baseline parameters and histopathological characteristics were compared between groups. Results: The study included 360 patients. In the DSR-negative group (17.8 per cent of all tumours) no patient had lateral lymph node or distant metastases at diagnosis or during follow-up, and all patients were biochemically cured. In the DSR-positive group (82.2 per cent of all tumours), lymph node and distant metastases were present in 31.4 and 6.4 per cent of patients respectively. DSR-negative tumours were more often stage pT1a and were significantly smaller. The median levels of basal calcitonin and carcinoembryonic antigen were significantly lower in the DSR-negative group, although when adjusted for T category both showed widely overlapping ranges. Conclusion: Lymph node surgery may be individualized in medullary thyroid cancer based on intraoperative analysis of the DSR. Patients with DSR-negative tumours do not require lateral lymph node dissection. (© The Author(s) 2020. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu