Skip to main content

Reoperative Experience with Papillary Thyroid Cancer



Intense postoperative monitoring has resulted in increasing detection of patients with recurrent papillary thyroid cancer (PTC). Our goals included quantifying successful reoperation, and analyzing surgical complications and reasons for relapse.


From 1999 to 2008, a total of 410 patients underwent reoperation for PTC relapse. We analyzed post-reoperative disease outcomes, reasons for relapse, and complications.


Bilateral reoperative thyroidectomy was performed in 13 (3 %) patients; lobectomy, 34 (8 %); central neck (VI) soft tissue local recurrence excision, 47 (11.5 %); bilateral VI node dissection, 107 (26 %); unilateral VI dissection, 112 (27 %); levels II–V dissection, 93 (23 %); levels III–V, 86 (21 %); lateral single- or two-compartment dissection, 51 (12 %); and node picking, 20 (5 %) of level VI and 53 (13 %) lateral neck. Complications occurred in 6 %; including hypoparathyroidism, 3 %; unintentional recurrent laryngeal nerve (RLN) paralysis, 3 %; phrenic nerve injury, 0.5 %; spinal accessory nerve injury, 0.5 %; and chyle leak in 1.6 %. Of 380 (93 %) patients with follow-up (mean 5.2 years); 274 (72 %) patients are alive with no structural evidence of disease, 38 % developed disease relapse (mean 2.1 years), 42 (11 %) died from PTC, and 55 (14 %) are alive with disease. The reason for relapse was a false negative pre-reoperative ultrasound (US) in 18 (5 %), nodal recurrence in the operative field in 37 (10 %), a combination of these two reasons in 10 (3 %), and disease virulence (local or systemic recurrence) in 81 (21 %).


Although 72 % of patients were rendered structurally disease free after reoperation, nearly 40 % suffered additional relapse. Improved surgical technique or preoperative localization might positively affect 15–20 %; at least 20 % reflect the biologic aggressiveness of the disease.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. Cooper D, Doherty G, Haugen B et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19(11):1167–1214

    PubMed  Article  Google Scholar 

  2. Schlumberger M (1998) Papillary and follicular thyroid carcinoma. N Engl J Med 338(5):297–306

    CAS  PubMed  Article  Google Scholar 

  3. Wang T, Dubner S, Sznyter L et al (2004) Incidence of metastatic well-differentiated thyroid cancer in cervical lymph nodes. Arch Otolaryngol Head Neck Surg 130:110–113

    PubMed  Article  Google Scholar 

  4. Robbins K, Shaha A, Medina J et al (2008) Consensus statement on the classification and terminology of neck dissection. Arch Otolaryngol Head Neck Surg 134:536–538

    PubMed  Article  Google Scholar 

  5. Clayman G, Shellenberger T, Ginsberg L et al (2009) Approach and safety of comprehensive central compartment dissection in patients with recurrent papillary thyroid carcinoma. Head Neck 31(9):1152–1163

    PubMed  Article  Google Scholar 

  6. Tufano R, Bishop J, Wu G (2012) Reoperative central compartment dissection for patients with recurrent/persistent papillary thyroid cancer: efficacy, safety, and the association of the BRAF mutation. Laryngoscope 122:1634–1640

    CAS  PubMed  Article  Google Scholar 

  7. 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(12):1069–1074

    PubMed  Article  Google Scholar 

  8. Schuff K, Weber S, Givi B et al (2008) Efficacy of nodal dissection for treatment of persistent/recurrent papillary thyroid cancer. Laryngoscope 118:768–775

    PubMed  Article  Google Scholar 

  9. Steward D (2012) Update in utility of secondary node dissection for papillary thyroid cancer. J Clin Endocrin Metab 97(10):3393–3398

    Article  Google Scholar 

  10. Shah M, Harris K, Nassif R et al (2012) Efficacy and safety of central compartment neck dissection for recurrent thyroid carcinoma. Arch Otolaryngol Head Neck Surg 138(1):33–37

    PubMed  Article  Google Scholar 

  11. Al-Saif O, Farrar W, Bloomston M et al (2010) Long-term efficacy of lymph node reoperation for persistent papillary thyroid cancer. J Clin Endocrin Metab 95:2187–2194

    CAS  Article  Google Scholar 

  12. Alvarado R, Sywak M, 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

    PubMed  Article  Google Scholar 

  13. Grant C, Stulak J, Thompson G et al (2010) Risks and adequacy of an optimized surgical approach to the primary surgical management of papillary thyroid carcinoma treated during 1999–2006. World J Surg 34:1239–1246. doi:10.1007/s00268-009-0307-9

    PubMed  Article  Google Scholar 

  14. Hay ID, Lee RA, Davidge-Pitts C et al (2013) Long-term outcome of ultrasound-guided percutaneous ethanol ablation of selected “recurrent” neck nodal metastases in 25 patients with TNM stages III or IVA papillary thyroid carcinoma previously treated by surgery and (131)I therapy. Surgery 154(6):1448–1455

    PubMed  Article  Google Scholar 

  15. Hay ID, Bergstralh EJ, Goellner JR et al (1993) Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery 114:1050–1058

    CAS  PubMed  Google Scholar 

  16. 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

    PubMed  Article  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Clive S. Grant.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Onkendi, E.O., McKenzie, T.J., Richards, M.L. et al. Reoperative Experience with Papillary Thyroid Cancer. World J Surg 38, 645–652 (2014).

Download citation

  • Published:

  • Issue Date:

  • DOI:


  • Recurrent Laryngeal Nerve
  • Papillary Thyroid Cancer
  • Lateral Neck
  • Central Neck
  • Central Neck Dissection