But de l'etude<space>: L'interet de la chirurgie iterative dans le carcinome medullaire de la thyroide (CMT) est encore controverse. Cette etude avait pour but d'evaluer les resultats a distance apres reinterventions pour CMT residuel ou recidivant.Patients et methodes<space>: Parmi les 136 patients operes dans notre centre pour CMT entre 1970 et 2000, 25 patients (dix hommes et 15 femmes) ont ete reoperes pour des lesions locoregionales residuelles ou recidivantes. L'age moyen etait 46 ans (extremes<space>: 19-73 ans). Il s'agissait dans 21 cas d'un CMT sporadique, dans quatre cas d'un CMT familial<space>: NEM 2A (n =<space>3), NEM 2B (n =<space>1). Dans 11 cas (44<space>%), operes dans un autre centre, la premiere intervention pratiquee avait ete une thyroidectomie totale<space>; chez deux patients (8<space>%) une thyroidectomie totale avec curage ganglionnaire central avait ete realisee et chez 12 patients (48<space>%) une thyroidectomie totale avec curage central et jugulocarotidien. A la suite de la premiere intervention, six patients (24<space>%) avaient ete classes au stade II, 15 (60<space>%) au stade III et quatre (16<space>%) au stade IV. Le dosage de la calcitonine basale et apres stimulation par pentagastrine, a ete pratique chez tous les patients avant et apres intervention.Resultats<space>: Trente-trois reinterventions ont ete effectuees. Dans 24 cas, les lesions etaient localisees dans la region laterocervicale, dans cinq cas il y avait un envahissement ganglionnaire central et laterocervical, dans deux cas un envahissement mediastinal et dans deux cas un envahissement spinal. Apres reintervention, la normalisation des taux de calcitonine a ete obtenue chez quatre patients (16<space>%) ; chez les 21 restants (84<space>%) la calcitonine est restee elevee. Apres un recul moyen de 110 mois (extremes<space>: 3<space>20-12), quatre patients (16<space>%) etaient vivants sans maladie decelable, deux (8<space>%) etaient morts a cause de leur maladie, 19 (76<space>%) etaient vivants avec persistance de leur maladie, dont cinq patients avec hypercalcitoninemie sans metastase decelable. En plus des patients ayant des metastases au moment de la reintervention, sept patients ont developpe secondairement des metastases (foie, os, poumon).Conclusion<space>: Les reinterventions pour CMT permettent rarement la guerison biologique. La reintervention peut limiter la progression de la maladie chez certains patients selectionnes. Une exerese complete des lesions, pratiquee de premiere intention doit etre le traitement ideal du CMT.
Study aim: The impact of iterative surgery in medullary thyroid carcinoma is still debated. The study aim was to evaluate long-term results following reoperation for residual or recurrent medullary thyroid carcinoma.Patients and method: Among the 136 patients operated on in our centre for medullary thyroid carcinoma (MTC) between 1970 and 2000, 25 patients (10 men and 15 women) were reoperated on for locoregional residual or recurrent lesions. Their mean age was 46 years (range: 19-73 years). The MTC was sporadic in 21 patients and familial in 4: NEM 2A (n=3), NEM 2B (n=1). In 11 patients (44%) operated in another centre, the first procedure was a total thyroidectomy; in 2 patients (8%) a total thyroidectomy with central lymphadenectomy was performed, and in 12 patients (48%) a total thyroidectomy with central and jugulo-carotid lymphadenectomy. After the first operation, 6 patients (24%) were classified stage II, 15 (60%) stage III and 4 (16%) stage IV. Basal and post-stimulation calcitonin dosages were performed for all the patients before and after reoperation.Results: Thirty three reoperations were performed. In 24 cases, the recurrence was located in the laterocervical site; in 5 cases, the lymph node involvement was both central and laterocervical, in 2 cases, there was a mediastinal involvement and in 2 cases a spinal involvement. After reoperation, the calcitonin rate became normal in 4 patients (16%) ; in the other 21 (84%), the calcitonin rate was still high. With a mean 110 month- follow-up (range: 320-12 months), 4 patients (16%) were alive without disease, 2 (8%) died of their disease, 19 (76%) were alive with their disease, five of them with hypercalcitonemia without detectable metastasis. In addition to patients having metastasis at the time of reoperation, seven developed metastases secondarily (liver, bone, lung).Conclusion: Biological cure of medullary thyroid carcinoma is rarely obtained with reoperation. Reoperations may reduce progression of the disease in selected patients. Complete removal of the lesions at the time of the first procedure must be the ideal treatment for medullary thyroid carcinoma.