Elsevier

Surgery

Volume 159, Issue 3, March 2016, Pages 755-762
Surgery

Endocrine
Recurrence of papillary thyroid carcinoma with lateral cervical node metastases: Predictive factors and operative management

https://doi.org/10.1016/j.surg.2015.08.033Get rights and content

Background

Lateral neck lymph node (LN) metastases (N1b) have been identified as independent risk factors of recurrence in patients with papillary thyroid carcinoma (PTC).

Objective

This study aimed to determine the predictive factors of recurrence in N1b PTC patients and to clarify the postoperative event patterns.

Methods

All patients who underwent operation for N1b PTC between 1978 and 2012 were reviewed. The median follow-up period was 6.5 years.

Results

In total, 344 N1b patients were included. Twenty-four patients (7%) were lost to long-term follow-up. Among the remaining 320 patients, the mean (±SD) follow-up time was 8.9 ± 8.8 years (median, 6.5; range, 2–36.4). Eighty-two patients (26%) presented with lymph node recurrence (LR). Multivariate analyses showed that LN metastases with extracapsular extension and the LN ratio (ratio between the number of N1 and number of resected LN) in the lateral compartment were independent predictors of recurrent disease. The median time to reoperation was 19 months (range, 3–173), with 79% of reoperations occurring within 2 years after the initial thyroidectomy. Reoperations for LR (75 patients) were performed in 76% of the patients with a focused minimal access approach or selective LN dissection. After curative reoperative surgery for recurrence, complications occurred in 6 patients (8%), including a 1% permanent complication rate.

Conclusion

Extranodal extension of LN metastases and the LN ratio in the lateral compartment are prognostic factors for recurrence. In most cases, reoperation for LR can be performed with a focused minimal access approach, with a low morbidity rate.

Section snippets

Patients and methods

A retrospective study of 1,751 consecutive patients who underwent surgery for PTC at our institution from January 1978 to December 2012 was conducted. Every patient underwent systematic preoperative neck US. We usually performed total thyroidectomy and LND in 1 step; if the diagnosis of PTC was made after lobectomy or isthmectomy, then LND was performed during a completion thyroidectomy. Therapeutic LND was performed in patients with clinically positive LNs, according to the findings of the

Results

Among the 1,751 PTC patients, 344 (20%) were N1bM0 patients. Characteristics of the patient and the PTC are summarized in Table I. In total, 129 patients (38%) underwent prophylactic LND; the remaining 215 patients underwent therapeutic LND.

Twenty-four patients (7%) were lost to long-term follow-up. Among the remaining 320 patients, the mean (±SD) follow-up was 8.9 ± 8.8 years (median, 6.5 years; range, 2–36.4 years). Recurrence (or persistence) was diagnosed in 102 patients (32%), including 5

Discussion

The strength of our study is the homogeneity of the therapeutic management of patients from a single institution with a long evaluation period that included a median follow-up time of 6.5 years. We showed that the persistence or recurrence rate among the patients with N1b PTC was 32%, including a 26% rate of locoregional events. These postoperative events occurred mostly within the first 2 years after the initial operation and were more frequent after a therapeutic LND during initial operation

References (33)

  • F.A. Verburg et al.

    Life expectancy is reduced in differentiated thyroid cancer patients ≥45 years old with extensive local tumor invasion, lateral lymph node, or distant metastases at diagnosis and normal in all other DTC patients

    J Clin Endocrinol Metab

    (2013)
  • Y. Ito et al.

    Lymph node recurrence in patients with N1b papillary thyroid carcinoma who underwent unilateral therapeutic modified radical neck dissection

    World J Surg

    (2012)
  • C.W. Lee et al.

    Risk factors for recurrence of papillary thyroid carcinoma with clinically node-positive lateral neck

    Ann Surg Oncol

    (2015)
  • M.H. Wu et al.

    Prognostic significance of extranodal extension of regional lymph node metastasis in papillary thyroid cancer

    Head Neck

    (2015)
  • A. Machens et al.

    Pattern of nodal metastasis for primary and reoperative thyroid cancer

    World J Surg

    (2002)
  • R. Ducoudray et al.

    Prophylactic lymph node dissection in papillary thyroid carcinoma: is there a place for lateral neck dissection?

    World J Surg

    (2013)
  • Cited by (61)

    • The Role of Node Dissection for Thyroid Cancer

      2021, Advances in Surgery
      Citation Excerpt :

      One helpful marker in determining the likelihood of a complete resection is the lymph node ratio, or the number of positive nodes divided by the total number of nodes removed. In general, higher ratios are associated with increased recurrence rates after central and lateral neck dissections [35–37]. Tumor markers can also gauge the completeness of resection, direct further management and estimate the risk of recurrence.

    • Management of Differentiated Thyroid Carcinoma in Pediatric Patients

      2021, Surgical Oncology Clinics of North America
      Citation Excerpt :

      In general, younger age, larger tumor size, solid architecture pattern, extensive tumor fibrosis, VI, disseminated psammoma bodies, extrathyroidal extension, node-positive disease with a high metastatic ratio index (>0.45), metastatic disease within the central compartment (level VI), macroscopic nodal disease, and extranodal extension are associated with a greater risk for ipsilateral or bilateral N1b disease.51,60,72,73 Overall survival is excellent, with 5-year survival rates of 99.8% in children with DTC confined to the thyroid and 97.1% of those with regional metastatic disease.5,74,75 Studies with long-term follow-up indicate that children with DTC have increased mortality from second malignancies, possibly related to radioactive iodine use.5,76,77

    • Treatment of recurrent disease in differentiated thyroid cancer

      2024, Journal of Xi'an Jiaotong University (Medical Sciences)
    • Nuclear medicine theranostics for the management of differentiated thyroid carcinoma

      2024, Journal of Xi'an Jiaotong University (Medical Sciences)
    View all citing articles on Scopus
    View full text