title: Reoperative lymph node dissection for recurrent papillary thyroid cancer and effect on serum thyroglobulin.
abstract: BACKGROUND
  Papillary thyroid cancer (PTC) has an excellent prognosis with current treatment methods. However, the rates of locoregional recurrence after initial surgical management remain significant. This study evaluates the effect of reoperative neck dissection for locoregional recurrence of PTC after initial total thyroidectomy and radioiodine therapy on the incidence of cervical recurrence and postoperative serum thyroglobulin (Tg) levels.
  
  
  METHODS
  This is a retrospective cohort study conducted in a single academic medical center of patients with recurrent or persistent PTC isolated to the neck after previous total thyroidectomy with or without lymph node dissection and adjuvant I(131) therapy who were treated with reoperative lymph node dissection. Outcomes including operative complications, pathologic findings, and effect of surgery on Tg levels and rates of recurrent disease were analyzed.
  
  
  RESULTS
  From 2001 to 2010, a total of 61 patients had reoperative neck dissections for recurrent cervical PTC with a complication rate of 5 %. Seventy-two percent of patients were clinically free of detectable disease, and 28 % of patients had recurrent, persistent, or newly metastatic disease detected during the follow-up period. All patients had significant decreases in Tg levels, with a median 98 % reduction in preoperative levels. However, only 21 % of patients had an undetectable stimulated Tg (<0.5 ng/mL) during the follow-up period of 15.5 months.
  
  
  CONCLUSIONS
  Reoperative treatment of recurrent or persistent PTC can be performed with low complication rates, and Tg levels greatly decrease in most patients; however, few achieve undetectable stimulated Tg.
authors.affiliation: Department of Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA. dhughes@montefiore.org
authors.forename: David T
authors.initials: DT
authors.lastname: Hughes
authors.forename: Amanda M
authors.initials: AM
authors.lastname: Laird
authors.forename: Barbra S
authors.initials: BS
authors.lastname: Miller
authors.forename: Paul G
authors.initials: PG
authors.lastname: Gauger
authors.forename: Gerard M
authors.initials: GM
authors.lastname: Doherty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000097:blood* / Q000473:pathology / Q000628:therapy; D002291:Carcinoma, Papillary; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D005260:Female; D005500:Follow-Up Studies; D020249:Hormone Replacement Therapy; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D037981:Neck Dissection / Q000009:adverse effects; D009364:Neoplasm Recurrence, Local / Q000097:blood* / Q000175:diagnosis / Q000601:surgery*; D018365:Neoplasm, Residual; D049268:Positron-Emission Tomography; D012086:Reoperation; D012189:Retrospective Studies; D013954:Thyroglobulin / Q000097:blood*; D000077273:Thyroid Cancer, Papillary; D013963:Thyroid Hormones / Q000627:therapeutic use; D013964:Thyroid Neoplasms / Q000097:blood* / Q000473:pathology / Q000628:therapy; D013965:Thyroidectomy; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D007457:Iodine Radioisotopes; D013963:Thyroid Hormones; D013954:Thyroglobulin