Reoperative lymph node dissection for recurrent papillary thyroid cancer and effect on serum thyroglobulin

David T. Hughes, Amanda M. Laird, Barbra S. Miller, Paul G. Gauger, Gerard M. Doherty

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background: Papillary thyroid cancer (PTC) has an excellent prognosis with current treatment methods. However, the rates of locoregional recurrence after initial surgical management remain significant. This study evaluates the effect of reoperative neck dissection for locoregional recurrence of PTC after initial total thyroidectomy and radioiodine therapy on the incidence of cervical recurrence and postoperative serum thyroglobulin (Tg) levels. Methods: This is a retrospective cohort study conducted in a single academic medical center of patients with recurrent or persistent PTC isolated to the neck after previous total thyroidectomy with or without lymph node dissection and adjuvant I 131 therapy who were treated with reoperative lymph node dissection. Outcomes including operative complications, pathologic findings, and effect of surgery on Tg levels and rates of recurrent disease were analyzed. Results: From 2001 to 2010, a total of 61 patients had reoperative neck dissections for recurrent cervical PTC with a complication rate of 5 %. Seventy-two percent of patients were clinically free of detectable disease, and 28 % of patients had recurrent, persistent, or newly metastatic disease detected during the follow-up period. All patients had significant decreases in Tg levels, with a median 98 % reduction in preoperative levels. However, only 21 % of patients had an undetectable stimulated Tg (<0.5 ng/mL) during the follow-up period of 15.5 months. Conclusions. Reoperative treatment of recurrent or persistent PTC can be performed with low complication rates, and Tg levels greatly decrease in most patients; however, few achieve undetectable stimulated Tg.

Original languageEnglish (US)
Pages (from-to)2951-2957
Number of pages7
JournalAnnals of Surgical Oncology
Volume19
Issue number9
DOIs
StatePublished - Sep 2012
Externally publishedYes

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Thyroglobulin
Lymph Node Excision
Serum
Neck Dissection
Thyroidectomy
Recurrence
Therapeutics
Papillary Thyroid cancer
Cohort Studies
Neck
Retrospective Studies
Incidence

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Reoperative lymph node dissection for recurrent papillary thyroid cancer and effect on serum thyroglobulin. / Hughes, David T.; Laird, Amanda M.; Miller, Barbra S.; Gauger, Paul G.; Doherty, Gerard M.

In: Annals of Surgical Oncology, Vol. 19, No. 9, 09.2012, p. 2951-2957.

Research output: Contribution to journalArticle

Hughes, David T. ; Laird, Amanda M. ; Miller, Barbra S. ; Gauger, Paul G. ; Doherty, Gerard M. / Reoperative lymph node dissection for recurrent papillary thyroid cancer and effect on serum thyroglobulin. In: Annals of Surgical Oncology. 2012 ; Vol. 19, No. 9. pp. 2951-2957.
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abstract = "Background: Papillary thyroid cancer (PTC) has an excellent prognosis with current treatment methods. However, the rates of locoregional recurrence after initial surgical management remain significant. This study evaluates the effect of reoperative neck dissection for locoregional recurrence of PTC after initial total thyroidectomy and radioiodine therapy on the incidence of cervical recurrence and postoperative serum thyroglobulin (Tg) levels. Methods: This is a retrospective cohort study conducted in a single academic medical center of patients with recurrent or persistent PTC isolated to the neck after previous total thyroidectomy with or without lymph node dissection and adjuvant I 131 therapy who were treated with reoperative lymph node dissection. Outcomes including operative complications, pathologic findings, and effect of surgery on Tg levels and rates of recurrent disease were analyzed. Results: From 2001 to 2010, a total of 61 patients had reoperative neck dissections for recurrent cervical PTC with a complication rate of 5 {\%}. Seventy-two percent of patients were clinically free of detectable disease, and 28 {\%} of patients had recurrent, persistent, or newly metastatic disease detected during the follow-up period. All patients had significant decreases in Tg levels, with a median 98 {\%} reduction in preoperative levels. However, only 21 {\%} of patients had an undetectable stimulated Tg (<0.5 ng/mL) during the follow-up period of 15.5 months. Conclusions. Reoperative treatment of recurrent or persistent PTC can be performed with low complication rates, and Tg levels greatly decrease in most patients; however, few achieve undetectable stimulated Tg.",
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