Complications after medullary thyroid carcinoma surgery: Multicentre study of the SQRTPA and EUROCRINE®databases

Abstract

Background: Surgery is the curative therapy for patients with medullary thyroid carcinoma (MTC). In determining the extent of surgery, the risk of complications should be considered. The aim of this study was to assess procedure-specific outcomes and risk factors for complications after surgery for MTC. Methods: Patients who underwent thyroid surgery for MTC were identified in two European prospective quality databases. Hypoparathyroidism was defined by treatment with calcium/active vitamin D. Recurrent laryngeal nerve (RLN) palsy was diagnosed on laryngoscopy. Complications were considered at least transient if present at last follow-up. Risk factors for at-least transient hypoparathyroidism and RLN palsy were identified by logistic regression analysis. Results: A total of 650 patients underwent surgery in 69 centres at a median age of 56 years. Hypoparathyroidism, RLN palsy and bleeding requiring reoperation occurred in 170 (262 per cent), 62 (137 per cent) and 17 (26 per cent) respectively. Factors associated with hypoparathyroidism were central lymph node dissection (CLND) (odds ratio (OR) 220, 95 per cent c.i. 104 to 467), CLND plus unilateral lateral lymph node dissection (LLND) (OR 278, 120 to 643), CLND plus bilateral LLND (OR 283, 113 to 705) and four or more parathyroid glands observed (OR 418, 146 to 1200). RLN palsy was associated with CLND plus LLND (OR 404, 112 to 1458) and T4 tumours (OR 1216, 446 to 3318). After compartment-oriented lymph node dissection, N0 status was achieved in 248 of 537 patients (462 per cent). Conclusion: Complications after surgery for MTC are procedure-specific and may relate to the unavoidable consequences of radical dissection needed in some patients.