Effect of reoperation on outcomes in papillary thyroid cancer.
BACKGROUND
The influence of lymph node recurrences of papillary thyroid carcinoma (PTC) on overall prognosis is uncertain. We performed a population-based, longitudinal analysis to evaluate the impact of reoperation on mortality.


METHODS
Patients who underwent initial operation for PTC >1 cm were abstracted from the California Cancer Registry database (1999-2008). Reoperation was defined as any lymph node dissection after total or near-total thyroidectomy.


RESULTS
Of the 11,986 patients included in the study, 222 (1.9%) underwent one or more reoperations. The median time to reoperation was 8.7 months, with 58.6% and 83.8% of reoperations being performed within 1 and 2 years of initial thyroidectomy, respectively. The mortality rate from PTC was 2.3% (271 patients). After we adjusted for age, sex, tumor size, stage, and radioactive iodine treatment, we found that reoperation was associated with an increased risk of all-cause mortality in patients ≥45 years of age (hazard ratio [HR] 1.51, P < .05). Reoperation was associated with an increased risk of disease-specific mortality in both patients <45 (HR 6.22, P < .01) and ≥45 (HR 2.49, P < .001).


CONCLUSIONS
Reoperation is independently associated with mortality in PTC. Most reoperations are performed soon after initial thyroidectomy and likely reflect persistent rather than recurrent disease.
Section of Endocrine Surgery, UCLA David Geffen School of Medicine, Los Angeles, CA.
Stephanie
S
Young
Avital
A
Harari
Stephanie
S
Smooke-Praw
Philip H G
PH
Ituarte
Michael W
MW
Yeh
D000328:Adult; D002140:California / Q000453:epidemiology; D002277:Carcinoma / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D002291:Carcinoma, Papillary / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012042:Registries; D012086:Reoperation; D012307:Risk Factors; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D013965:Thyroidectomy
D007457:Iodine Radioisotopes