title: Recurrence of papillary thyroid carcinoma with lateral cervical node metastases: Predictive factors and operative management.
abstract: BACKGROUND
  Lateral neck lymph node (LN) metastases (N1b) have been identified as independent risk factors of recurrence in patients with papillary thyroid carcinoma (PTC).
  
  
  OBJECTIVE
  This study aimed to determine the predictive factors of recurrence in N1b PTC patients and to clarify the postoperative event patterns.
  
  
  METHODS
  All patients who underwent operation for N1b PTC between 1978 and 2012 were reviewed. The median follow-up period was 6.5 years.
  
  
  RESULTS
  In total, 344 N1b patients were included. Twenty-four patients (7%) were lost to long-term follow-up. Among the remaining 320 patients, the mean (± SD) follow-up time was 8.9 ± 8.8 years (median, 6.5; range, 2-36.4). Eighty-two patients (26%) presented with lymph node recurrence (LR). Multivariate analyses showed that LN metastases with extracapsular extension and the LN ratio (ratio between the number of N1 and number of resected LN) in the lateral compartment were independent predictors of recurrent disease. The median time to reoperation was 19 months (range, 3-173), with 79% of reoperations occurring within 2 years after the initial thyroidectomy. Reoperations for LR (75 patients) were performed in 76% of the patients with a focused minimal access approach or selective LN dissection. After curative reoperative surgery for recurrence, complications occurred in 6 patients (8%), including a 1% permanent complication rate.
  
  
  CONCLUSIONS
  Extranodal extension of LN metastases and the LN ratio in the lateral compartment are prognostic factors for recurrence. In most cases, reoperation for LR can be performed with a focused minimal access approach, with a low morbidity rate.
authors.affiliation: Department of General and Endocrine Surgery, Hospital Pitié Salpêtrière, APHP, University Pierre and Marie Curie (Paris VI), Paris, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Chéreau
authors.affiliation: Department of Nuclear Medicine, Hospital Pitié Salpêtrière, APHP, University Pierre and Marie Curie (Paris VI), Paris, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Buffet
authors.affiliation: Department of General and Endocrine Surgery, Hospital Pitié Salpêtrière, APHP, University Pierre and Marie Curie (Paris VI), Paris, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Trésallet
authors.affiliation: Department of Pathology, Hospital Pitié Salpêtrière, APHP, University Pierre and Marie Curie (Paris VI), Paris, France.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Tissier
authors.affiliation: Department of Nuclear Medicine, Hospital Pitié Salpêtrière, APHP, University Pierre and Marie Curie (Paris VI), Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Leenhardt
authors.affiliation: Department of General and Endocrine Surgery, Hospital Pitié Salpêtrière, APHP, University Pierre and Marie Curie (Paris VI), Paris, France. Electronic address: fabrice.menegaux@psl.aphp.fr.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Menegaux
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D002277:Carcinoma / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D002291:Carcinoma, Papillary; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009333:Neck; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D011237:Predictive Value of Tests; D011379:Prognosis; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods; D016896:Treatment Outcome; D055815:Young Adult