title: Surgery for Neck Recurrence of Differentiated Thyroid Cancer: Outcomes and Risk Factors.
abstract: Persistent/recurrent disease in the neck is frequent in patients with differentiated thyroid cancer (DTC).
  
  
  
  Assess efficacy, safety, and prognostic factors of first neck reoperation in DTC.
  
  
  
  Retrospective study of consecutive patients undergoing neck reoperation for recurrent/persistent DTC in a referral cancer center. Response after reoperation was defined according to the 2015 American Thyroid Association guidelines.
  
  
  
  One hundred sixty-one DTC patients were enrolled (64% females, median age 35 years, 96% papillary DTC). Initial stage was pT3 in 43% and pT4 in 10%, pN1 in 74%. Aggressive histology was present in 25% of the patients, in both primary and persistent/recurrent tumor. Four patients had no malignancy in the reoperative specimen, and 1 patient died due to postoperative hematoma and was excluded from further analysis. Following reoperation, 15 patients (10%) had persistent structural disease, 16 (10%) had biochemical incomplete response, 26 (17%) had indeterminate response, and 99 (63%) had complete response (CR), among whom 24 relapsed later. After a median follow-up of 5 years, only 83 patients (53%) had CR without the need for further treatments. The rate of permanent complications was: hypoparathyroidism 2%, laryngeal nerve palsy 0.6%, other 6%. Age ≥45 years, aggressive histology, and lymph node ratio ≥0.6 at initial surgery were independent risk factors for incomplete response after reoperation. Male sex, aggressive histology, and ≥10 metastases at reoperation were independent risk factors of secondary relapse following CR achieved with reoperation.
  
  
  
  A careful risk-benefit analysis should guide surgical decision, particularly in patients with risk factors for incomplete response.
authors.affiliation: Department of Nuclear Medicine and Endocrine Oncology and.
authors.forename: Livia
authors.initials: L
authors.lastname: Lamartina
authors.affiliation: Department of Biostatistics and Epidemiology.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Borget
authors.affiliation: Department of Surgery.
authors.forename: Haitham
authors.initials: H
authors.lastname: Mirghani
authors.affiliation: Department of Medical Biology and Pathology, and.
authors.forename: Abir
authors.initials: A
authors.lastname: Al Ghuzlan
authors.affiliation: Department of Nuclear Medicine and Endocrine Oncology and.
authors.forename: Amandine
authors.initials: A
authors.lastname: Berdelou
authors.affiliation: Department of Radiology, Gustave Roussy and Université Paris Saclay, 94805 Villejuif, France.
authors.forename: François
authors.initials: F
authors.lastname: Bidault
authors.affiliation: Department of Nuclear Medicine and Endocrine Oncology and.
authors.forename: Désirée
authors.initials: D
authors.lastname: Deandreis
authors.affiliation: Department of Nuclear Medicine and Endocrine Oncology and.
authors.forename: Eric
authors.initials: E
authors.lastname: Baudin
authors.affiliation: Department of Surgery.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Travagli
authors.affiliation: Department of Nuclear Medicine and Endocrine Oncology and.
authors.forename: Martin
authors.initials: M
authors.lastname: Schlumberger
authors.affiliation: Department of Surgery.
authors.forename: Dana M
authors.initials: DM
authors.lastname: Hartl
authors.affiliation: Department of Nuclear Medicine and Endocrine Oncology and.
authors.forename: Sophie
authors.initials: S
authors.lastname: Leboulleux
mesh_terms: D018263:Adenocarcinoma, Follicular / Q000473:pathology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D002291:Carcinoma, Papillary; D002648:Child; D005260:Female; D006801:Humans; D007011:Hypoparathyroidism / Q000453:epidemiology; D008198:Lymph Nodes; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009333:Neck; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009378:Neoplasms, Multiple Primary / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012086:Reoperation / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy; D016896:Treatment Outcome; D047368:Tumor Burden; D014826:Vocal Cord Paralysis / Q000453:epidemiology; D055815:Young Adult