Abstract
Background
Although reoperative surgery in the central compartment (RCND) is indicated for bulky or progressive persistent/recurrent papillary thyroid carcinoma (PTC), its associated morbidity and disease outcomes remain unclear. We evaluated RCND outcomes by comparing them with those of patients who underwent primary central neck dissection (CND).
Methods
After matching for age, sex, tumor size, and initial tumor stage, the morbidity and outcomes of 50 consecutive patients who underwent RCND were compared with data from 75 patients who underwent primary therapeutic CND during the same period. Matching was performed blind to the morbidity and disease outcome of each patient. A stimulated thyroglobulin (sTg) <2 ng/ml was considered undetectable.
Results
Relative to primary CND, the incidence of extranodal extension (p = 0.010) and size of metastatic lymph nodes (p < 0.001) were significantly greater in the RCND group. Postoperative hypoparathyroidism and vocal cord palsy rates were comparable in the groups. There were two esophageal injuries in the RCND group and none in the primary CND group. The secondary CND group achieved a significantly lower undetectable postablation sTg rate (12.0 vs. 52.0 %, p = 0.001) and worse 10-year disease-free survival (35.6 vs. 91.8 %, p = 0.001) and cancer-specific survival (82.0 vs. 98.5 %, p = 0.001) than the primary CND group.
Conclusions
Although RCND for persistent/recurrent PTC was performed with morbidity comparable to that seen with primary CND, it was associated with some serious complications. Short- and long-term disease control appeared moderate with approximately one-tenth of patients having an undetectable sTg level 6 months after ablation and one-third remaining clinically disease-free after 10 years.
Similar content being viewed by others
References
Anonymous (2013) Cancer incidence and mortality in Hong Kong 1983–2010. Hong Kong Cancer Registry, Hong Kong. http://www3.ha.org.hk/cancereg/. Accessed 15 Jan 2013
Anonymous (2011) SEER Cancer Statistics Review, 1975–2008. National Cancer Institute Surveillance Epidemiology and End Results. http://seer.cancer.gov/csr/1975_2008
Wong H, Wong KP, Yau T et al (2012) Is there a role for unstimulated thyroglobulin velocity in predicting recurrence in papillary thyroid carcinoma patients with detectable thyroglobulin after radioiodine ablation? Ann Surg Oncol 19:3479–3485
Cooper DS, Doherty GM, Hauger BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214
Steward DL (2012) Update in utility of secondary node dissection for papillary thyroid cancer. J Clin Endocrinol Metab 97:3393–3398
Clayman GL, Agarwal G, Edeiken BS et al (2011) Long-term outcome of comprehensive central compartment dissection in patients with recurrent/persistent papillary thyroid carcinoma. Thyroid 21:1309–1316
Farrag TY, Agrawal N, Sheth S et al (2007) Algorithm for safe and effective reoperative thyroid bed surgery for recurrent/persistent papillary thyroid carcinoma. Head Neck 29:1069–1074
Ito Y, Higashiyama T, Takamura Y et al (2011) Prognosis of patients with papillary thyroid carcinoma showing postoperative recurrence to the central neck. World J Surg 35:767–772. doi:10.1007/s00268-010-0924-3
Alvarado R, Sywak MS, Delbridge L et al (2009) Central lymph node dissection as a secondary procedure for papillary thyroid cancer: is there added morbidity? Surgery 145:514–518
Shen WT, Ogawa L, Ruan D et al (2010) Central neck lymph node dissection for papillary thyroid cancer: comparison of complication and recurrence rates in 295 initial dissections and reoperations. Arch Surg 145:272–275
Kim MK, Mandel SH, Baloch Z et al (2004) Morbidity following central compartment reoperation for recurrent or persistent thyroid cancer. Arch Otolaryngol Head Neck Surg 130:1214–1216
Roh JL, Kim JM, Park CI (2011) Central compartment reoperation for recurrent/persistent differentiated thyroid cancer: patterns of recurrence, morbidity, and prediction of postoperative hypocalcemia. Ann Surg Oncol 18:1312–1318
Ondik MP, Dezfoli S, Lipinski L et al (2009) Secondary central compartment surgery for thyroid cancer. Laryngoscope 119:1947–1950
Al-Saif O, Farrar WB, Bloomston M et al (2010) Long-term efficacy of lymph node reoperation for persistent papillary thyroid cancer. J Clin Endocrinol Metab 95:2187–2194
Shah MD, Harris LD, Nassif RG et al (2012) Efficacy and safety of central compartment neck dissection for recurrent thyroid carcinoma. Arch Otolaryngol Head Neck Surg 138:33–37
Chan WF, Lang BH, Lo CY (2006) The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: a comparative study on 1,000 nerves at risk. Surgery 140:866–872 discussion 872–873
Lang BH, Wong KP, Wan KY et al (2012) Impact of routine unilateral central neck dissection on preablative and postablative stimulated thyroglobulin levels after total thyroidectomy in papillary thyroid carcinoma. Ann Surg Oncol 19:60–67
Lang BH, Chow SM, Lo CY et al (2007) Staging systems for papillary thyroid carcinoma: a study of 2 tertiary referral centers. Ann Surg 246:114–121
Farrag TY, Agrawal N, Sheth S et al (2007) Algorithm for safe and effective reoperative thyroid bed surgery for recurrent/persistent papillary thyroid carcinoma. Head Neck 29:1069–1074
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lang, B.HH., Lee, G.C.C., Ng, C.P.C. et al. Evaluating the Morbidity and Efficacy of Reoperative Surgery in the Central Compartment for Persistent/Recurrent Papillary Thyroid Carcinoma. World J Surg 37, 2853–2859 (2013). https://doi.org/10.1007/s00268-013-2202-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-013-2202-7