title: Efficacy of nodal dissection for treatment of persistent/recurrent papillary thyroid cancer.
abstract: 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.
authors.affiliation: Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health and Science University, Portland, Oregon 97239, USA.
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Schuff
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Weber
authors.forename: Babak
authors.initials: B
authors.lastname: Givi
authors.forename: Mary H
authors.initials: MH
authors.lastname: Samuels
authors.forename: Peter E
authors.initials: PE
authors.lastname: Andersen
authors.forename: James I
authors.initials: JI
authors.lastname: Cohen
mesh_terms: 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
chemical_list: D013954:Thyroglobulin