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Long-Term Efficacy of Lymph Node Reoperation for Persistent Papillary Thyroid Cancer: 13-Year Follow-Up

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Current recommendations for persistent or recurrent locoregional papillary thyroid cancer (PTC) include consideration of surgical resection versus active surveillance. The purpose of this study is to determine long-term outcomes after surgical resection of recurrent or persistent metastatic PTC in cervical lymph nodes after failure of initial surgery and radioactive iodine therapy using newer validated clinical outcomes measures.

Methods

Outcomes of 70 patients who underwent cervical lymphadenectomy (n = 110) from 1999 to 2013 for recurrent or persistent locoregional PTC metastases were reviewed. Measures included biochemical remission (BCR) based on Tg levels, American Thyroid Association classifications for response to treatment [biochemical incomplete response (BIR), structural incomplete response (SIR), indeterminate response (IR), and excellent response (ER)], need for reoperation, surgical complications, disease progression, and death.

Results

The median follow-up was 13.1 years, with only two additional reoperations since 2010, one of which had no metastasis on pathology with the other developing anaplastic thyroid cancer in background PTC. ER was achieved in 31 (44%) patients, all of whom remained in ER at time of last follow-up (median 14.1 years). There were no structural recurrences in patients with persistent BIR or IR after reoperation. Patients with SIR had stable disease, except for one who died due to anaplastic thyroid cancer.

Conclusions

Patients who achieved ER after reoperation had no need for further treatment. Patients with persistent detectable Tg levels after reoperation rarely developed structural recurrence. ATA outcomes can be safely used to guide treatment decisions over a decade after reoperation for PTC.

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Acknowledgements

Funding support for this paper is through National Cancer Institute Award Number Grants P50 CA168505 (Thyroid SPORE) and P01 CA124570 from the National Cancer Institute, Award Number Grant KL2TR002734 from the National Center For Advancing Translational Sciences, and Award Number Grant 1T32AI106704-01A1 (Advanced Research Training in Immunology for Surgery Trainees) from the National Institute of Allergy and Infectious Diseases. The research reported in this publication and the content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA

    Amblessed E. Onuma MD, Eliza W. Beal MD, William B. Farrar MD, John Phay MD & Lawrence A. Shirley MD

  2. Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA

    Fadi Nabhan MD & Matthew D. Ringel MD

  3. Department of Surgery, Division of Surgical Oncology, University of Michigan, Ann Arbor, MI, USA

    Tasha Hughes MD

  4. Department of Medical Affairs, Veracyte, Inc., South San Francisco, CA, USA

    Richard T. Kloos MD

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  1. Amblessed E. Onuma MD
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  8. Richard T. Kloos MD
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Correspondence to Lawrence A. Shirley MD.

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Onuma, A.E., Beal, E.W., Nabhan, F. et al. Long-Term Efficacy of Lymph Node Reoperation for Persistent Papillary Thyroid Cancer: 13-Year Follow-Up. Ann Surg Oncol 26, 1737–1743 (2019). https://doi.org/10.1245/s10434-019-07263-5

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  • DOI: https://doi.org/10.1245/s10434-019-07263-5

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