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