World Journal of Surgery

, Volume 38, Issue 3, pp 653–659 | Cite as

Patterns of Structural Recurrence in Papillary Thyroid Cancer

  • Schelto Kruijff
  • Japke F. Petersen
  • Paul Chen
  • Ahmed M. Aniss
  • Roderick J. Clifton-Bligh
  • Stan B. Sidhu
  • Leigh W. Delbridge
  • Anthony J. Gill
  • Diana Learoyd
  • Mark S. SywakEmail author



Papillary thyroid carcinoma (PTC) is uncommonly associated with tumor-related mortality, although local recurrence can be a frequent and difficult problem. This study was conducted to clarify the pattern of structural locoregional recurrence in PTC.

Material and method

A retrospective cohort study of patients undergoing surgical intervention for PTC was undertaken. Data were collected from a comprehensive thyroid cancer database maintained within a single tertiary referral center. The primary outcome measure was cancer recurrence requiring surgical intervention. Secondary outcome measures were site of recurrence, time to recurrence, and risk factors for recurrence.


In the period 1980–2013, 1,183 patients with PTC were included in the study. The overall rate of structural recurrence requiring reoperative surgery was 7.9 %. The median time to reoperation was 31 months. Younger age, male gender, large primary tumor diameter, and number of positive lymph nodes at initial presentation were all significantly associated with disease recurrence. The lateral compartments (levels I, II, III, IV, V) were involved almost twice as frequently as the central compartment (level VI) (67 vs 32 %, P < 0.01). The distribution of recurrences was level I (1 %), level II (12 %), level III (18 %), level IV (18 %), level V (17 %), level VI (32 %), level VII (2 %).


In a center with a liberal approach to central compartment lymph node dissection for PTC, the lateral neck compartment is the most common site of structural recurrence requiring reoperative surgery.


Papillary Thyroid Carcinoma Papillary Thyroid Cancer Central Compartment Lateral Compartment Extrathyroidal Extension 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Davies L, Welch HG (2006) Increasing incidence of thyroid cancer in the United States 1973–2002. JAMA 295:2164–2167PubMedCrossRefGoogle Scholar
  2. 2.
    Malterling RR, Andersson RE, Falkmer S et al (2010) Differentiated thyroid cancer in a Swedish county-long-term results and quality of life. Acta Oncol 49:454–459PubMedCrossRefGoogle Scholar
  3. 3.
    Grodski S, Cornford L, Sywak M et al (2007) Routine level VI lymph node dissection for papillary thyroid cancer: surgical technique. ANZ J Surg 77:203–208PubMedCrossRefGoogle Scholar
  4. 4.
    Moo TA, McGill J, Allendorf J et al (2010) Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma. World J Surg 34:1187–1191. doi: 10.1007/s00268-010-0418-3 PubMedCrossRefGoogle Scholar
  5. 5.
    Enyioha C, Roman SA, Sosa JA (2013) Central lymph node dissection in patients with papillary thyroid cancer: a population level analysis of 14,257 cases. Am J Surg 205(6):655–661PubMedCrossRefGoogle Scholar
  6. 6.
    Sywak M, Cornford L, Roach P et al (2006) Routine ipsilateral level VI lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery 140:1000–1005PubMedCrossRefGoogle Scholar
  7. 7.
    Hartl DM, Leboulleux S, Al Ghuzlan A et al (2012) Optimization of staging of the neck with prophylactic central and lateral neck dissection for papillary thyroid carcinoma. Ann Surg 255:777–783PubMedCrossRefGoogle Scholar
  8. 8.
    Scheumann GF, Gimm O, Wegener G et al (1994) Prognostic significance and surgical management of locoregional lymph node metastases in papillary thyroid cancer. World J Surg 18:559–567. doi: 10.1007/BF00353765 PubMedCrossRefGoogle Scholar
  9. 9.
    Lundgren CI, Hall P, Dickman PW et al (2006) Clinically significant prognostic factors for differentiated thyroid carcinoma: a population-based, nested case–control study. Cancer 106:524–531PubMedCrossRefGoogle Scholar
  10. 10.
    White ML, Gauger PG, Doherty GM (2007) Central lymph node dissection in differentiated thyroid cancer. World J Surg 31:895–904. doi: 10.1007/s00268-006-0907-6 PubMedCrossRefGoogle Scholar
  11. 11.
    Young A, Harari A, Smooke-Praw S et al (2013) Effect of re-operation on outcomes in papillary thyroid cancer. Surgery (submitted)Google Scholar
  12. 12.
    Giles Senyurek Y, Tunca F, Boztepe H et al (2009) The long term outcome of papillary thyroid carcinoma patients without primary central lymph node dissection: expected improvement of routine dissection. Surgery 146:1188–1195PubMedCrossRefGoogle Scholar
  13. 13.
    Kouvaraki MA, Shapiro SE, Fornage BD et al (2003) Role of preoperative ultrasonography in the surgical management of patients with thyroid cancer. Surgery 134:946–954PubMedCrossRefGoogle Scholar
  14. 14.
    Choi JS, Kim J, Kwak JY et al (2009) Preoperative staging of papillary thyroid carcinoma: comparison of ultrasound imaging and CT. AJR Am J Roentgenol 193:871–878PubMedCrossRefGoogle Scholar
  15. 15.
    Popadich A, Levin O, Lee JC et al (2011) A multicenter cohort study of total thyroidectomy and routine central lymph node dissection for cN0 papillary thyroid cancer. Surgery 150:1048–1057PubMedCrossRefGoogle Scholar
  16. 16.
    Pacini F, Castagna MG, Brilli L, The ESMO Guidelines Working Group et al (2009) Differentiated thyroid cancer: ESMO clinical recommendations for diagnosis, treatment and follow-up. Ann Oncol 20(Suppl 4):143–146PubMedGoogle Scholar
  17. 17.
    Henry JF, Gramatica L, Denizot A et al (1998) Morbidity of prophylactic lymph node dissection in the central neck area in patients with papillary thyroid carcinoma. Langenbecks Arch Surg 383:167–169PubMedCrossRefGoogle Scholar
  18. 18.
    Shaha AR (2007) TNM classification of thyroid carcinoma. World J Surg 31:879–887. doi: 10.1007/s00268-006-0864-0 PubMedCrossRefGoogle Scholar
  19. 19.
    Cooper S, Doherty G, Huagen B et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214PubMedCrossRefGoogle Scholar
  20. 20.
    Zetoune T, Keutgen X, Buitrago D et al (2010) Prophylactic central neck dissection and local recurrence in papillary thyroid cancer: a meta-analysis. Ann Surg Oncol 17:3287–3293PubMedCrossRefGoogle Scholar
  21. 21.
    Hartl DM, Mamelle E, Borget I et al (2013) Influence of prophylactic neck dissection on rate of retreatment for papillary thyroid carcinoma. World J Surg 37:1951–1958. doi: 10.1007/s00268-013-2089-3 PubMedCrossRefGoogle Scholar
  22. 22.
    Machens A, Hinze R, Thomusch O et al (2002) Patterns of nodal metastasis for primary and reoperative thyroid cancer. World J Surg 26:22–28. doi: 10.1007/s00268-001-0176-3 PubMedCrossRefGoogle Scholar
  23. 23.
    Zaydfudim V, Feurer ID, Griffin MR et al (2008) The impact of lymph node involvement on survival in patients with papillary and follicular thryroid carcinoma. Surgery 144:1070–1077PubMedCrossRefGoogle Scholar
  24. 24.
    Caron NR, Tan YY, Ogilvie JB et al (2006) Selective modified radical neck dissection for papillary thyroid cancer—is level I, II and IV dissection always neccesary? World J Surg 30:833–840. doi: 10.1007/s00268-005-0358-5 PubMedCrossRefGoogle Scholar
  25. 25.
    Roh JL, Park JY, Park CI (2009) Prevention of postoperative hypocalcemia with routine oral calcium and vitamin D supplements in patients with differentiated papillary thryoid carcinoma undergoing total thyroidectomy plus central neck dissection. Cancer 115:251–258PubMedCrossRefGoogle Scholar
  26. 26.
    Lim YS, Lee JC, Lee YS et al (2011) Lateral cervical lymph node metastases from papillary thyroid carcinoma: predictive factors of nodal metastasis. Surgery 150:116–121PubMedCrossRefGoogle Scholar
  27. 27.
    Kim C, Bi X, Pan D et al (2013) The risk of second cancers after diagnosis of primary thyroid cancer is elevated in thyroid microcarcinomas. Thyroid 23:575–582PubMedCrossRefGoogle Scholar
  28. 28.
    Brown AP, Chen J, Hitchcock YJ et al (2008) The risk of second primary malignancies up to three decades after the treatment of differentiated thyroid cancer. J Clin Endocrinol Metab 93:504–515PubMedCrossRefGoogle Scholar
  29. 29.
    Kruijff S, Chen P, Aniss A et al (2013) Lowering doses of radioiodine for remnant ablation does not increase structural recurrence rates in papillary thyroid carcinoma. Surgery (accepted)Google Scholar
  30. 30.
    Schlumberger M, Catargi B, Borget I et al (2012) Strategies of radioiodine ablation in patients with low-risk thyroid cancer. N Engl J Med 366:1163–1673CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Schelto Kruijff
    • 1
  • Japke F. Petersen
    • 1
  • Paul Chen
    • 1
  • Ahmed M. Aniss
    • 1
  • Roderick J. Clifton-Bligh
    • 2
  • Stan B. Sidhu
    • 1
  • Leigh W. Delbridge
    • 1
  • Anthony J. Gill
    • 3
  • Diana Learoyd
    • 2
  • Mark S. Sywak
    • 1
    Email author
  1. 1.University of Sydney Endocrine Surgery UnitRoyal North Shore HospitalSt. Leonards, SydneyAustralia
  2. 2.Department of EndocrinologyRoyal North Shore HospitalSt. Leonards, SydneyAustralia
  3. 3.Department of Anatomical PathologyRoyal North Shore HospitalSt. Leonards, SydneyAustralia

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