title: Recurrence pattern after conservative surgery for papillary thyroid carcinoma.
abstract: OBJECTIVE
  Risk-based treatment represents the optimal management strategy for papillary thyroid carcinoma; however, the optimal extent of thyroidectomy and neck dissection remains controversial. This study aims to clarify the pattern of recurrence after conservative surgery in patients with papillary thyroid carcinoma.
  
  
  METHODS
  We retrospectively reviewed 93 patients with papillary thyroid carcinoma treated with conservative surgery. We analyzed recurrence rate, recurrence pattern, risk factors for recurrence, salvage treatment, and disease-free survival (DFS) in patients stratified according to risk.
  
  
  RESULTS
  The recurrence rate was significantly lower in the low-risk group compared with the high-risk group (14% vs 34%; p<0.01). The recurrence pattern also differed between the two groups, with ipsilateral lateral neck recurrence being more common in the low-risk group (9%), while contralateral lateral neck recurrence was more common in the high-risk group (18%). Patients with contralateral thyroid lobe metastasis and/or direct contralateral thyroid lobe invasion showed a significantly higher rate of contralateral lateral neck metastasis than patients negative for both these features. The overall 5-year DFS was 81% in all patients. Advanced T and N classification, large primary tumor (≥4cm), extrathyroidal invasion, and high-risk group were significantly associated with poorer 5-year DFS in univariate analysis.
  
  
  CONCLUSIONS
  Conservative surgery may represent a good treatment option for patients with low-risk papillary thyroid carcinoma. Tumor recurrence patterns differ between risk groups, with contralateral thyroid lobe lesions and direct contralateral lobe invasion being risk factors for contralateral lateral neck recurrence.
authors: Department of Otolaryngology, Head and Neck Surgery, Takeda General Hospital, Japan; Department of Otolaryngology, Head and Neck Surgery, The University of Tokyo Hospital, Tokyo, Japan. Electronic address: kenyajp@hotmail.com.
authors: Kenya
authors: K
authors: Kobayashi
authors: Department of Otolaryngology, Head and Neck Surgery, Takeda General Hospital, Japan.
authors: Shigeo
authors: S
authors: Takenouchi
authors: Department of Head and Neck Surgery, The Cancer Institute Hospital, Japan.
authors: Hiroki
authors: H
authors: Mitani
authors: Department of Otolaryngology, Head and Neck Surgery, Takeda General Hospital, Japan.
authors: Tuyoshi
authors: T
authors: Yoshida
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D002291:Carcinoma, Papillary; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy / Q000706:statistics & numerical data; D000077273:Thyroid Cancer, Papillary; D013961:Thyroid Gland / Q000473:pathology / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D055815:Young Adult
keywords: Conservative surgery; Papillary thyroid carcinoma; Pattern of recurrence; Risk-based treatment