Efficacy of nodal dissection for treatment of persistent/recurrent papillary thyroid cancer.
BACKGROUND
Although commonly performed, data are lacking regarding efficacy and safety of lymph node dissection (LND) for recurrent/persistent papillary thyroid cancer (PTC).


OBJECTIVE
Evaluate the efficacy and morbidity of LND in recurrent/persistent PTC.


METHODS
Retrospective review of central or lateral LND performed for persistent/recurrent PTC between January 2004 and March 2006.


METHODS
Multidisciplinary thyroid cancer clinic with a single surgeon at an academic medical center.


METHODS
Seventy-five patients who underwent 79 LND for persistent/residual PTC. Safety analysis included all 79 resections. Exclusion criteria for the efficacy analysis were factors prohibiting evaluation of thyroglobulin (Tg) response. Forty-one resections were included in the efficacy analysis.


METHODS
Selective LND per standard of care.


METHODS
Primary outcome was the Tg response to LND. Secondary outcomes were surgical complications.


RESULTS
Thirty-nine of the 41 evaluable resections also had Tg data allowing classification of Tg response. Of 39 classifiable resections, 16 (41%) resulted in undetectable postoperative stimulated Tg levels. An additional 12 resections resulted in significant (> or =50%) reductions in suppressed or stimulated Tg levels for an overall improvement rate of 72%. Of all 79 resections, 25 (32%) resulted in minor and 7 (9%) resulted in major complications.


CONCLUSIONS
LND for persistent/recurrent PTC is a relatively safe procedure in experienced hands. It can lead to an undetectable Tg in 41% of cases and produce a major Tg reduction in an additional 31%. Its efficacy in short-term follow-up is comparable with that reported for I-131, and it should be considered in the management of persistent/recurrent PTC.
Schuff
Kathryn G
KG
Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health and Science University, Portland, Oregon 97239, USA.
Weber
Stephen M
SM
Givi
Babak
B
Samuels
Mary H
MH
Andersen
Peter E
PE
Cohen
James I
JI
D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D002291:Carcinoma, Papillary / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D010348:Patient Care Team; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000379:methods; D013954:Thyroglobulin / Q000097:blood; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome
D013954:Thyroglobulin