The Outcomes of First Reoperation for Locoregionally Recurrent/Persistent Papillary Thyroid Carcinoma in Patients Who Initially Underwent Total Thyroidectomy and Remnant Ablation

Yim JH , Kim WB , Kim EY , Kim WG , Kim TY , Ryu JS , Gong G , Hong SJ , Shong YK

J Clin Endocrinol Metab April, 2011

The primary treatment of locoregionally recurrent/persistent papillary thyroid cancer (PTC) is surgical removal by reoperation. This study evaluated the efficacy of the first reoperation for loco-regionally recurrent/persistent papillary thyroid carcinoma and the usefulness of stimulated TG for evaluating efficacy of reoperation. A retrospective observational cohort study was done in a tertiary referral hospital. A total of 83 patients, who underwent initial total thyroidectomy and nodal dissection with radioactive iodine remnant ablation, received reoperation for loco-regionally recurrent/persistent PTC and were included in this study. Stimulated TG levels were assessed before and after reoperation. We assessed biochemical remission (stimulated TG<1 ng/ml) after reoperation and evaluated second clinical recurrence-free survival rate according to stimulated TG value

There was a significant positive correlation between the numbers of resected malignant lymph nodes and the reduction in stimulated TG level after reoperation. Biochemical remission was achieved in 51% of patients who underwent first reoperation. Patients with stimulated TG level greater than 5 ng/ml after first reoperation had a greater chance of a second clinical recurrence (the estimated 5 yr clinical recurrence free survival rate, 94 ± 3 vs.74 ± 9%, P < 0.001).

Surgery is an effective option for managing locally recurrent/persistent PTC. Stimulated TG is a useful marker for evaluating efficacy of reoperation and predicting second recurrence in loco-regionally recurrent/persistent PTC.

Comment

Reoperation for local recurrence in the neck is of course a common proceedure. But it is useful to have statistics showing that in half of the patients the procedure induced a œbiochemical and clinical remission AN IMPORT GUIDELINE NOW AVAILABLE