Central Compartment Reoperation for Recurrent/Persistent Differentiated Thyroid Cancer

To the Editors:

We thank Dr. Roh and colleagues for touching on the issue of reoperative thyroid surgery for differentiated thyroid cancer and sharing their experience.1 We discussed the article in our journal club, and the following queries were generated out of our discussion. We hope that the authors will clarify these matters.

• 1. On what criteria have the authors selected cases for unilateral or bilateral lymph node dissection?

• 2. What policy was followed while performing frozen section biopsy of parathyroid glands? The authors mentioned that identified parathyroid glands whose vascularity is jeopardized have been subjected to frozen section biopsy.

• 3. What was the status of patients who underwent completion thyroidectomy before coming to their center? Have any patients underwent lymph node dissection in this group, and what was the status of parathyroids in this group?

• 4. Can the authors clarify whether organs were shaved or resected? The authors mention that organ (trachea or esophagus) was shaved off or resected and repaired when tumors invaded them. However, in Table 2, only tracheal resection is mentioned.

• 5. Do the authors have any experience treating patients who underwent primary surgery at their own center (as most of the patients included were referred to them after primary surgery at other institutions)? If so, were these patients comparable?

• 6. The authors had investigated the patients many times for hypocalcemia, including the morning of surgery and many times after surgery, but their complete results were not shown except the results for iPTH at 1 hour and 1 day postoperatively. Was it cost-effective?