Efficacy of nodal dissection for treatment of persistent/recurrent papillary thyroid cancer

Kathryn G. Schuff, Stephen M. Weber, Babak Givi, Mary H. Samuels, Peter E. Andersen, James I. Cohen

Research output: Contribution to journalArticlepeer-review

51 Scopus citations

Abstract

CONTEXT: Although commonly performed, data are lacking regarding efficacy and safety of lymph node dissection (LND) for recurrent/persistent papillary thyroid cancer (PTC). OBJECTIVE: Evaluate the efficacy and morbidity of LND in recurrent/persistent PTC. DESIGN: Retrospective review of central or lateral LND performed for persistent/recurrent PTC between January 2004 and March 2006. SETTING: Multidisciplinary thyroid cancer clinic with a single surgeon at an academic medical center. PARTICIPANTS: Seventy-five patients who underwent 79 LND for persistent/residual PTC. Safety analysis included all 79 resections. Exclusion criteria for the efficacy analysis were factors prohibiting evaluation of thyroglobulin (Tg) response. Forty-one resections were included in the efficacy analysis. INTERVENTION: Selective LND per standard of care. MAIN OUTCOME MEASURE: Primary outcome was the Tg response to LND. Secondary outcomes were surgical complications. RESULTS: Thirty-nine of the 41 evaluable resections also had Tg data allowing classification of Tg response. Of 39 classifiable resections, 16 (41%) resulted in undetectable postoperative stimulated Tg levels. An additional 12 resections resulted in significant (≥50%) reductions in suppressed or stimulated Tg levels for an overall improvement rate of 72%. Of all 79 resections, 25 (32%) resulted in minor and 7 (9%) resulted in major complications. CONCLUSIONS: LND for persistent/recurrent PTC is a relatively safe procedure in experienced hands. It can lead to an undetectable Tg in 41% of cases and produce a major Tg reduction in an additional 31%. Its efficacy in short-term follow-up is comparable with that reported for I-131, and it should be considered in the management of persistent/recurrent PTC.

Original languageEnglish (US)
Pages (from-to)768-775
Number of pages8
JournalLaryngoscope
Volume118
Issue number5
DOIs
StatePublished - May 1 2008

Keywords

  • Neck dissection
  • Papillary thyroid cancer
  • Radioiodine
  • Recurrence
  • Thyroglobulin
  • Thyroidectomy

ASJC Scopus subject areas

  • Otorhinolaryngology

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