J Endocr Surg.  2019 Dec;19(4):116-125. 10.16956/jes.2019.19.4.116.

Relationship between Initial Thyroid Operation and the Location of Locoregional Recurrence in Papillary Thyroid Cancer: a Single Tertiary Center Experience

• Rah CS
• Chang JG
• Kim WW
• Lee YM
• Jeon MJ
• Song DE
• Choi YJ
• Chung KW
• Hong SJ
• Sung TY

• KMID: 2466237
• DOI: http://doi.org/10.16956/jes.2019.19.4.116

Abstract

PURPOSE
Locoregional recurrence of papillary thyroid cancer (PTC) after initial thyroid operation is frequent in high-risk patients. However, many studies have reported on risk factors for recurrence without presenting the actual location or patterns of these recurrences. We evaluated the efficacy of initial thyroid operation, which could affect the location of recurrence and prognosis of PTC, thereby requiring reoperation.
METHODS
This was a retrospective observational cohort study of patients undergoing initial thyroidectomy for PTC with recurrences during follow-up at a single tertiary center.
RESULTS
In total, 210 (12.8%) first recurrences and 23 (1.4%) second recurrences were detected after the initial thyroid operation. Recurrences occurred mostly after total thyroidectomy (TT) with central compartment node dissection (CCND) (51.5%) and TT with lateral neck node dissection (LND) (27.5%). The most frequent site of the first locoregional recurrence was the lateral neck node area at the non-operated site of the initial thyroid operation (67.1%). Among patients with a second recurrence, 91.3% had a first recurrence within 5 years after operation.
CONCLUSION
Patients receiving TT with CCND or TT with LND should undergo a thorough examination of lateral neck node area during follow-up, especially at the non-operated lateral neck site. In addition, close observation for a second recurrence is needed for patients with a first recurrence in the early years after the initial operation.

Keyword

Papillary thyroid cancer; Initial thyroid operation; Locoregional recurrence; Non-operated site; Initial operated site

MeSH Terms

Cohort Studies
Follow-Up Studies
Humans
Neck
Prognosis
Recurrence*
Reoperation
Retrospective Studies
Risk Factors
Thyroid Gland*
Thyroid Neoplasms*
Thyroidectomy

Reference

1. Mazzaferri EL, Jhiang SM. Long-term impact of initial surgical and medical therapy on papillary and follicular thyroid cancer. Am J Med. 1994; 97:418–428.

2. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016; 26:1–133.

3. Tubiana M, Schlumberger M, Rougier P, Laplanche A, Benhamou E, Gardet P, et al. Long-term results and prognostic factors in patients with differentiated thyroid carcinoma. Cancer. 1985; 55:794–804.

4. Jeon MJ, Kim WG, Jang EK, Choi YM, Lee YM, Sung TY, et al. Thyroglobulin level in fine-needle aspirates for preoperative diagnosis of cervical lymph node metastasis in patients with papillary thyroid carcinoma: two different cutoff values according to serum thyroglobulin level. Thyroid. 2015; 25:410–416.

5. Moon WJ, Jung SL, Lee JH, Na DG, Baek JH, Lee YH, et al. Benign and malignant thyroid nodules: US differentiation--multicenter retrospective study. Radiology. 2008; 247:762–770.

6. Lamartina L, Grani G, Biffoni M, Giacomelli L, Costante G, Lupo S, et al. Risk stratification of neck lesions detected sonographically during the follow-up of differentiated thyroid cancer. J Clin Endocrinol Metab. 2016; 101:3036–3044.

7. Sung TY, Yoon JH, Song DE, Lee YM, Kim TY, Chung KW, et al. Prognostic value of the number of retrieved lymph nodes in pathological Nx or N0 classical papillary thyroid carcinoma. World J Surg. 2016; 40:2043–2050.

8. Lee YM, Sung TY, Kim WB, Chung KW, Yoon JH, Hong SJ. Risk factors for recurrence in patients with papillary thyroid carcinoma undergoing modified radical neck dissection. Br J Surg. 2016; 103:1020–1025.

9. Randolph GW, Duh QY, Heller KS, LiVolsi VA, Mandel SJ, Steward DL, et al. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid. 2012; 22:1144–1152.

10. Kim HI, Kim TH, Choe JH, Kim JH, Kim JS, Kim YN, et al. Surgeon volume and prognosis of patients with advanced papillary thyroid cancer and lateral nodal metastasis. Br J Surg. 2018; 105:270–278.

11. Lamartina L, Borget I, Mirghani H, Al Ghuzlan A, Berdelou A, Bidault F, et al. Surgery for neck recurrence of differentiated thyroid cancer: outcomes and risk factors. J Clin Endocrinol Metab. 2017; 102:1020–1031.

12. Al-Saif O, Farrar WB, Bloomston M, Porter K, Ringel MD, Kloos RT. Long-term efficacy of lymph node reoperation for persistent papillary thyroid cancer. J Clin Endocrinol Metab. 2010; 95:2187–2194.

13. Yim JH, Kim WB, Kim EY, Kim WG, Kim TY, Ryu JS, et al. The outcomes of first reoperation for locoregionally recurrent/persistent papillary thyroid carcinoma in patients who initially underwent total thyroidectomy and remnant ablation. J Clin Endocrinol Metab. 2011; 96:2049–2056.

14. Dávila-Cervantes A, Gamino R, González O, Herrera MF. Surgical treatment of recurrent differentiated thyroid carcinoma. Eur J Surg Suppl. 2003; 14–17.

15. Hughes DT, Laird AM, Miller BS, Gauger PG, Doherty GM. Reoperative lymph node dissection for recurrent papillary thyroid cancer and effect on serum thyroglobulin. Ann Surg Oncol. 2012; 19:2951–2957.

16. Rondeau G, Fish S, Hann LE, Fagin JA, Tuttle RM. Ultrasonographically detected small thyroid bed nodules identified after total thyroidectomy for differentiated thyroid cancer seldom show clinically significant structural progression. Thyroid. 2011; 21:845–853.

17. Robenshtok E, Fish S, Bach A, Domínguez JM, Shaha A, Tuttle RM. Suspicious cervical lymph nodes detected after thyroidectomy for papillary thyroid cancer usually remain stable over years in properly selected patients. J Clin Endocrinol Metab. 2012; 97:2706–2713.

18. Monchik JM, Donatini G, Iannuccilli J, Dupuy DE. Radiofrequency ablation and percutaneous ethanol injection treatment for recurrent local and distant well-differentiated thyroid carcinoma. Ann Surg. 2006; 244:296–304.

19. Lim CY, Yun JS, Lee J, Nam KH, Chung WY, Park CS. Percutaneous ethanol injection therapy for locally recurrent papillary thyroid carcinoma. Thyroid. 2007; 17:347–350.

20. Schuff KG, Weber SM, Givi B, Samuels MH, Andersen PE, Cohen JI. Efficacy of nodal dissection for treatment of persistent/recurrent papillary thyroid cancer. Laryngoscope. 2008; 118:768–775.

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

22. Tran B, Roshan D, Abraham E, Wang L, Garibotto N, Wykes J, et al. An analysis of The American Joint Committee on Cancer 8th edition T staging system for papillary thyroid carcinoma. J Clin Endocrinol Metab. 2018; 103:2199–2206.

23. Kim H, Kim TH, Choe JH, Kim JH, Kim JS, Oh YL, et al. Patterns of initial recurrence in completely resected papillary thyroid carcinoma. Thyroid. 2017; 27:908–914.