Extension of Prophylactic Surgery in Medullary Thyroid Carcinoma. Differences Between Sporadic and Hereditary Tumours According to Calcitonin Levels and Lymph Node Involvement.

INTRODUCTION: Currently, there is no consensus on the indication of prophylactic surgery of the nodal compartments in the treatment of medullary thyroid carcinoma (MTC). The aim of our study was to perform a correlation study between preoperative calcitonin (basalCT) values and lymph node involvement to establish a criterion on which to base prophylactic surgery in these patients. MATERIAL AND METHODS: We conducted an observational, retrospective and multicentre study with 29 hospitals. Patients over 18 years of age with a diagnosis of MTC with a pre-surgical calcitonin registry were included. The minimum surgery in all patients had to have been total thyroidectomy (TT) with central compartment lymph node dissection (CCLND). Receiver operating characteristic (ROC) curve analysis was used to establish basalCT cut-off values as predictors of postoperative lymph node involvement. RESULTS: A total of 244 patients were included. Baseline calcitonin (basalCT) was a good predictor of nodal involvement (AUC 0.718 and 95%CI 0.66-0.978). Heritability was identified as a preoperative factor correlated with baseline tumour CT values (p = 0.000). With a probability of lymph node involvement below 10%, new cut-off points were established. A prophylactic bilateral lateral lymph node dissection in sporadic tumours should be performed at a basalCT > 600 pg/mL; in the case of RET-mutated tumours this value would be 200 pg/mL. CONCLUSION: The baseline CT value is a good predictor of postoperative lymph node involvement in MTC, however, cut-off points should depent on the hereditary nature of the tumour.

Invaginaciones intestinales en el adulto de causa tumoral / Adult intestinal invaginations of tumoral origin

Propósito: Destacar la importancia de la patología neoplásica como una de las causas más fundamentales de las invaginaciones intestinales en el adulto.• Material y Métodos: Estudio descriptivo restrospectivo de invaginaciones intestinales en nuestro Centro de 1996 a 2000.• Resultados: Se presentaron once casos de invaginaciones (7 mujeres: 4 hombres) con una edad media de 54 años. La clínica más frecuente resultó la obstrucción intestinal, y el diagnóstico preoperatorio fue llevado a cabo en 6 casos, lo más habitual por medio de enema opaco. El tratamiento fue la laparotomía, demostrándose 6 lipomas, 2 adenocarcinomas, un leiomiosarcoma, una metástasis de melanoma cutáneo y un hematoma mural. En 10 casos se realizó resección intestinal según criterios oncológicos.• Conclusiones: En las invaginaciones intestinales en el adulto, son de gran importancia una adecuada sospecha clínica y diagnóstica, porque la correcta terapéutica quirúrgica llevará a su resolución, en cuyo origen subyace muchas veces una patología neoplásica. (AU)