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

2016 ◽  
pp. 115-126
Author(s):  
Randall P. Scheri ◽  
Sanziana A. Roman ◽  
Julie Ann Sosa
Keyword(s):  
Thyroid Cancer ◽  
Neck Dissection ◽  
Surgical Management ◽  
Medullary Thyroid Cancer ◽  
Lateral Neck ◽  
Lateral Neck Dissection ◽  
Medullary Thyroid ◽  
Thyroid Resection

scholarly journals The Role of IONM in Reducing the Occurrence of Shoulder Syndrome Following Lateral Neck Dissection for Thyroid Cancer

2021 ◽  
Vol 10 (18) ◽  
pp. 4246
Author(s):  
Andrea Polistena ◽  
Monia Ranalli ◽  
Stefano Avenia ◽  
Roberta Lucchini ◽  
Alessandro Sanguinetti ◽  
...  
Keyword(s):  
Thyroid Cancer ◽  
Neck Dissection ◽  
High Volume ◽  
Accessory Nerve ◽  
Lateral Neck ◽  
Lateral Neck Dissection ◽  
Metastatic Node ◽  
Node Ratio ◽  
Shoulder Syndrome

Lateral neck dissection (LND) leads to a significant morbidity involving accessory nerve injury. Modified radical neck dissection (MRND) aims at preservation of the accessory nerve, but patients often present with negative functional outcomes after surgery. The role of neuromonitoring (IONM) in the prevention of shoulder syndrome has not yet been defined in comparison to nerve visualization only. We retrospectively analyzed 56 thyroid cancer patients who underwent MRND over a period of six years (2015–2020) in a high-volume institution. Demographic variables, type of surgical procedure, removed lymph nodes and the metastatic node ratio, pathology, adoption of IONM and shoulder functional outcome were investigated. The mean number of lymph nodes removed was 15.61, with a metastatic node ratio of 0.2745. IONM was used in 41.07% of patients, with a prevalence of 68% in the period 2017–2020. IONM adoption showed an effect on post-operative shoulder function. There were no effects in 89.29% of cases, and temporary and permanent effects in 8.93% and 1.79%, respectively. Confidence intervals and two-sample tests for equality of proportions were used when applicable. Expertise in high-volume centres and IONM during MRND seem to be correlated with a reduced prevalence of accessory nerve lesions and limited functional impairments. These results need to be confirmed by larger prospective randomized controlled trials.

YAP confers resistance to vandetanib in medullary thyroid cancer

2020 ◽  
Vol 98 (3) ◽  
pp. 443-448
Author(s):  
Huan Wang ◽  
Jian Tang ◽  
Zhiwei Su
Keyword(s):  
Thyroid Cancer ◽  
Medullary Thyroid Cancer ◽  
Critical Role ◽  
Acquired Resistance ◽  
Resistant Cell ◽  
Resistant Cell Line ◽  
Antitumor Effects ◽  
Medullary Thyroid ◽  
Tt Cells

Medullary thyroid cancer (MTC) is the third most common thyroid cancer. RET (Rearranged in Transformation) gene mutations are considered as one of the major drivers of MTC. Vandetanib suppresses RET activity, and has shown promise in clinical trials. Unfortunately, acquired resistance to vandetanib has been observed in MTC, although the mechanism was largely unknown. We investigated the critical role of YAP (Yes-Associated Protein) on vandetanib resistance in MTC. For this, TT cells (medullary thyroid cancer cells) were treated with vandetanib for 3 months to generate a vandetanib-resistant cell line (TT-R). We investigated the role of YAP on vandetanib-resistance in TT-R cells by performing cell proliferation and colony formation assays, and examined the antitumor effects of YAP inhibitor and vandetanib in a mouse model of xenografted MTC. The TT-R cells displayed 6-fold higher IC50 to vandetanib than the TT cells. Overexpression of YAP resulted in resistance to vandetanib, whereas knockdown of YAP re-sensitized the TT-R cells to vandetanib. The YAP inhibitor synergized with vandetanib on tumor inhibition. Our results suggest that YAP plays an important role in acquired resistance to vandetanib in MTC, providing basis for combating MTC with YAP inhibitor and vandetanib.

Surgical management of medullary thyroid cancer: which guidelines should we follow?

2015 ◽  
Vol 129 (5) ◽  
pp. 478-483 ◽  
Author(s):  
A Bowen ◽  
N Mani ◽  
S Penney ◽  
S Loughran ◽  
B Yap
Keyword(s):  
Thyroid Cancer ◽  
Surgical Management ◽  
Medullary Thyroid Cancer ◽  
Stage I ◽  
Disease Stage ◽  
American Thyroid Association ◽  
Cure Rate ◽  
Aggressive Approach ◽  
Medullary Thyroid ◽  
Biochemical Cure

AbstractBackground:Surgery is currently the only curative treatment for medullary thyroid cancer. Unfortunately, the surgical strategy that will offer patients at each disease stage the best chance of a biochemical cure remains unclear. The American Thyroid Association and British Thyroid Association guidelines offer different strategies.Methods:A retrospective analysis of the surgical management of 47 patients with medullary thyroid cancer diagnosed between 1994 and 2013 was performed. Surgical management was compared with current American Thyroid Association and British Thyroid Association guidelines. Outcome was defined as the first post-operative calcitonin measurement.Results:All patients with stage I–III disease achieved a post-operative biochemical cure regardless of the guidelines followed. The overall biochemical cure rate for patients with stage IVa disease was significantly reduced to 10 per cent (p < 0.01), but the biochemical cure rate for stage IVa disease patients who underwent bilateral lateral lymph node dissection was 33.3 per cent.Conclusion:The conservative, surveillance-driven approach recommended by the American Thyroid Association is appropriate for stage I–III disease. However, the more aggressive approach advocated by the British Thyroid Association might provide stage IVa disease patients a greater chance of achieving a biochemical cure.

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