title: Risk Factors for Re-recurrence After First Reoperative Surgery for Locoregional Recurrent/Persistent Papillary Thyroid Carcinoma.
abstract: BACKGROUND
  Papillary thyroid carcinoma (PTC) is generally an indolent tumor indicative of favorable prognosis. However, post-treatment recurrences may be problematic, and management strategies for recurrent disease have not been established. This study investigated risk factors associated with re-recurrence of PTC after reoperative surgery.
  
  
  METHODS
  This study included 151 patients with pathologically confirmed recurrent/persistent PTC who underwent reoperation. Clinical factors, operative and pathologic findings, serum thyroglobulin levels, postoperative complications, and recurrences were examined. Univariate and multivariate analyses were performed to identify factors associated with re-recurrence-free survival (RFS) after reoperative surgery.
  
  
  RESULTS
  Recurrent tumors were found in thyroid remnants or previous resection bed (n=28), central nodes (n=48), and lateral neck nodes (n=102). Biochemical complete remission (stimulated thyroglobulin<1 ng/mL) was achieved in 69 (51.5%) patients after reoperative surgery. Permanent vocal fold paralysis and hypoparathyroidism developed in 6 (4.1%) and 4 (2.8%) patients, respectively. Vocal fold paralysis occurred primarily due to intentional nerve resection following tumor invasion. During a median follow-up of 57.5 months, 41 (27.2%) patients had re-recurrences. Univariate analyses showed that extranodal extension (p=0.028), recurrent laryngeal nerve invasion (p=0.037), as well as stimulated (p=0.001) and unstimulated (p=0.015) serum thyroglobulin were significant predictors of RFS. Multivariate analyses showed that postoperative biochemical remission independently predicted RFS (p=0.014).
  
  
  CONCLUSIONS
  Postoperative thyroglobulin after reoperative surgery predicted re-recurrence. Careful follow-up of these patients after reoperation is recommended.
authors.affiliation: Department of Otolaryngology, Asan Medical Centre, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
authors.forename: Hwan Seo
authors.initials: HS
authors.lastname: Lee
authors.forename: Jong-Lyel
authors.initials: JL
authors.lastname: Roh
authors.forename: Gyungyup
authors.initials: G
authors.lastname: Gong
authors.forename: Kyung-Ja
authors.initials: KJ
authors.lastname: Cho
authors.forename: Seung-Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Soon Yuhl
authors.initials: SY
authors.lastname: Nam
authors.forename: Sang Yoon
authors.initials: SY
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D002291:Carcinoma, Papillary; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007011:Hypoparathyroidism / Q000209:etiology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications; D011379:Prognosis; D012074:Remission Induction; D012086:Reoperation / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D013954:Thyroglobulin / Q000097:blood; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods; D014826:Vocal Cord Paralysis / Q000209:etiology; D055815:Young Adult
chemical_list: D013954:Thyroglobulin
references.citation: Laryngoscope. 2008 May;118(5):768-75
references.pmid: 18197134
references.citation: Ann Surg Oncol. 2012 Sep;19(9):2951-7
references.pmid: 22526913
references.citation: Cancer. 2006 Feb 1;106(3):524-31
references.pmid: 16369995
references.citation: World J Surg. 2011 Apr;35(4):767-72
references.pmid: 21181469
references.citation: Otolaryngol Clin North Am. 2008 Dec;41(6):1147-54, ix
references.pmid: 19040975
references.citation: Am J Med. 1994 Nov;97(5):418-28
references.pmid: 7977430
references.citation: Thyroid. 2013 Nov;23(11):1401-7
references.pmid: 23517313
references.citation: Ann Surg Oncol. 2014 Jun;21(6):1884-90
references.pmid: 24515566
references.citation: Thyroid. 2009 Nov;19(11):1167-214
references.pmid: 19860577
references.citation: Arch Otolaryngol Head Neck Surg. 2008 May;134(5):536-8
references.pmid: 18490577
references.citation: Ann Surg Oncol. 2015 Jan;22(1):117-24
references.pmid: 25034816
references.citation: Ann Surg. 2007 Apr;245(4):604-10
references.pmid: 17414610
references.citation: J Clin Endocrinol Metab. 2005 Mar;90(3):1440-5
references.pmid: 15613412
references.citation: Arch Otolaryngol Head Neck Surg. 2004 Oct;130(10):1214-6
references.pmid: 15492172
references.citation: Ann Surg Oncol. 2011 Aug;18(8):2245-50
references.pmid: 21327454
references.citation: Ann Surg. 1996 May;223(5):472-8; discussion 478-80
references.pmid: 8651738
references.citation: J Clin Endocrinol Metab. 2010 May;95(5):2187-94
references.pmid: 20332244
references.citation: Thyroid. 2012 Nov;22(11):1144-52
references.pmid: 23083442
references.citation: J Clin Endocrinol Metab. 2011 Jul;96(7):2049-56
references.pmid: 21508143
references.citation: Ann Surg Oncol. 2013 Feb;20(2):653-9
references.pmid: 22956067
references.citation: Thyroid. 2013 Sep;23(9):1099-105
references.pmid: 23421588
references.citation: Am J Surg. 1996 Dec;172(6):692-4
references.pmid: 8988680
references.citation: World J Surg. 2012 Jun;36(6):1274-8
references.pmid: 22270990
references.citation: Br J Surg. 2013 Mar;100(4):497-503
references.pmid: 23254479
references.citation: Ann Surg. 2003 Mar;237(3):399-407
references.pmid: 12616125
references.citation: World J Surg. 2009 Mar;33(3):434-9
references.pmid: 18958519
references.citation: Laryngoscope. 1990 Aug;100(8):824-30
references.pmid: 2381258