Surgical Management of Sporadic Medullary Thyroid Cancer (Extent of Thyroid Resection and the Role of Central and Lateral Neck Dissection)

Abstract

Sporadic medullary thyroid cancer (MTC) encompasses approximately 70–75 % of patients diagnosed with MTC. The American Thyroid Association (ATA) published revised guidelines for the management of MTC in 2015. In their 66 recommendations, surgery remains the mainstay of treatment for sporadic MTC; lymph node metastases are frequent and occur even with early-stage primary tumors, arguing for aggressive compartment-oriented lymph node dissections in patients without suspected distant metastases. Administration of vandetanib or cabozantinib is indicated for patients with progressive MTC that is locally advanced and unresectable, or associated with progressive distant metastases not amenable to surgical excision. Optimally, patients with MTC should be referred to high-volume endocrine centers with experienced multidisciplinary teams and high-volume thyroid surgeons in order to enhance patient outcomes and facilitate enrollment in MTC clinical databases and clinical trials studying novel treatments of metastatic MTC.