title: The outcomes of first reoperation for locoregionally recurrent/persistent papillary thyroid carcinoma in patients who initially underwent total thyroidectomy and remnant ablation.
abstract: BACKGROUND
  The primary treatment of locoregionally recurrent/persistent papillary thyroid cancer (PTC) is surgical removal by reoperation. However, there had been only limited number of reports on the outcome of reoperation.
  
  
  OBJECTIVE
  This study was to evaluate the efficacy of the first reoperation for locoregionally recurrent/persistent papillary thyroid carcinoma and the usefulness of stimulated thyroglobulin for evaluating efficacy of reoperation.
  
  
  METHODS
  This was a retrospective observational cohort study in a tertiary referral hospital.
  
  
  METHODS
  A total of 83 patients, who underwent initial total thyroidectomy and nodal dissection with radioactive iodine remnant ablation, received reoperation for locoregionally recurrent/persistent PTC and were included in this study. Stimulated thyroglobulin levels were assessed before and after reoperation.
  
  
  METHODS
  We assessed biochemical remission (stimulated thyroglobulin <1 ng/ml) after reoperation and evaluated second clinical recurrence-free survival rate according to stimulated thyroglobulin value.
  
  
  RESULTS
  There was a significant positive correlation between the numbers of resected malignant lymph nodes and the reduction in stimulated thyroglobulin level after reoperation. Biochemical remission was achieved in 51% of patients who underwent first reoperation. Patients with stimulated thyroglobulin level greater than 5 ng/ml after first reoperation had a greater chance of a second clinical recurrence (the estimated 5 yr clinical recurrence free survival rate, 94 ± 3 vs.74 ± 9%, log rank statistics 15.8, df = 1, P < 0.001).
  
  
  CONCLUSIONS
  Surgery is an effective option for managing locally recurrent/persistent PTC. Stimulated thyroglobulin is a useful marker for evaluating efficacy of reoperation and predicting second recurrence in locoregionally recurrent/persistent PTC.
authors.affiliation: Departments of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea.
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Yim
authors.forename: Won Bae
authors.initials: WB
authors.lastname: Kim
authors.forename: Eui Young
authors.initials: EY
authors.lastname: Kim
authors.forename: Won Gu
authors.initials: WG
authors.lastname: Kim
authors.forename: Tae Yong
authors.initials: TY
authors.lastname: Kim
authors.forename: Jin-Sook
authors.initials: JS
authors.lastname: Ryu
authors.forename: Gyungyub
authors.initials: G
authors.lastname: Gong
authors.forename: Suck Joon
authors.initials: SJ
authors.lastname: Hong
authors.forename: Young Kee
authors.initials: YK
authors.lastname: Shong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002291:Carcinoma, Papillary / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D012074:Remission Induction; D012086:Reoperation; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy; D016896:Treatment Outcome