title: Long-term outcome of comprehensive central compartment dissection in patients with recurrent/persistent papillary thyroid carcinoma.
abstract: BACKGROUND
  Persistent or recurrent papillary thyroid carcinoma (PTC) occurs in some patients after initial thyroid surgery and often, radioactive iodine treatment. Here, we identify the efficacy, safety, and long-term outcome of our current surgical management paradigm for persistent/recurrent PTC in the central compartment in an interdisciplinary thyroid cancer clinical and research program at a tertiary thyroid cancer referral center.
  
  
  METHODS
  We retrospectively analyzed our standardized approach of comprehensive bilateral level VI/VII lymph node dissection (SND [VI, VII]) for cytologically confirmed PTC in the central compartment.
  
  
  RESULTS
  From 1994 to 2004, 210 patients, median age 42 (range 12-82) underwent SND (VI, VII). Most patients (106, 51%) had already undergone ≥2 surgical procedures for persistent or recurrent disease, and 31 (15%) had distant metastases at presentation. Postoperatively, 104 (71%) of the 146 patients who were thyroglobulin (Tg) positive had no evidence of disease. Anti-Tg antibodies were present in 38 patients (18%), 17 of whom (53%) did not have anti-Tg antibodies postoperatively. Fourteen patients (7%) were hypoparathyroid at presentation, and 2 more (1%) became permanently hypoparathyroid after surgery. Four patients (2%) experienced recurrent laryngeal nerve paralysis (RLNP) of a previously functioning nerve. Unanticipated RLNP was observed in only one nerve at risk. External beam radiation was given to 33 patients (17%). An additional 17 patients (8%) developed distant metastases during follow-up. At the last follow-up, 130 (66%) of the 196 patients had no detectable Tg; of these, 99 (76%) had no further evidence of disease. A median of 7.25 years after surgery, 167 (90%) of the 185 patients were without evidence of central disease, and 18 (10%) had developed central compartment recurrences within a median interval of 24.3 months. Of those with recurrence, 16 out of 18 patients (89%) underwent a subsequent surgical procedure, thus resulting in an overall 98% central compartment control rate. Kaplan-Meier disease-specific survival at 10 years was 98.9% for patients <45 years old and 77.9% for those ≥45 years old (log-rank p<0.00001). The only predictor of central compartment recurrence was malignancy in a thyroid remnant noted within the central compartment surgical specimen.
  
  
  CONCLUSIONS
  Bilateral comprehensive level VI/VII dissections are safe and effective for long-term control of recurrent/persistent PTC in the central lymphatic compartment.
authors.affiliation: Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030-4009, USA. gclayman@mdanderson.org
authors.forename: Gary L
authors.initials: GL
authors.lastname: Clayman
authors.forename: Garima
authors.initials: G
authors.lastname: Agarwal
authors.forename: Beth S
authors.initials: BS
authors.lastname: Edeiken
authors.forename: Steven G
authors.initials: SG
authors.lastname: Waguespack
authors.forename: Dianna B
authors.initials: DB
authors.lastname: Roberts
authors.forename: Steven I
authors.initials: SI
authors.lastname: Sherman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001323:Autoantibodies / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood; D002277:Carcinoma; D002291:Carcinoma, Papillary; D016009:Chi-Square Distribution; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007011:Hypoparathyroidism / Q000209:etiology; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013781:Texas; D013954:Thyroglobulin / Q000097:blood / Q000276:immunology; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000276:immunology / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000209:etiology; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D014408:Biomarkers, Tumor; C006606:anti-thyroglobulin; D013954:Thyroglobulin