Abstract
Objective
To determine the patterns of cervical LN disease recurrence in the lateral and central neck in patients with recurrent/persistent papillary thyroid cancer undergoing reoperative surgery. Recommendation of level dissection.
Methods
We reviewed the charts of 45 consecutive patients (February 2002-November 2007) with PTC who underwent first-time reoperative surgery by the senior author (R.P.T) for recurrent/persistent PTC.
Results
43 had PTC, and 2 had PTC with tall cell variant on final pathology. 38 underwent unilateral neck dissection; 7 had bilateral neck dissection, with a total of 52 lateral neck dissections. 48/52(92%) were + for metastasis. Level II was dissected in 46/52(88%) and was + in 30/46(65%) times. Level III was dissected in 46/52(88%) and was + in 30/ 46(65%) times. Level IV was dissected in 50/52(97%) and was + in 38/50(76%) times. Level V was dissected in 25/52(48%) and was + in 14/25(56%) times. Size of largest LN ranged from (0.5 to 3) cm. 18/46(39%) had extra-nodal spread. 25/ 45(55%) had reoperative bed surgery and all had + metastasis; where 22/25(88%) had also + lateral LN, while 3/25(12%) had - lateral LN.
Conclusions
Patients undergoing lateral neck dissection for persistent/recurrent PTC are likely to harbor metastatic disease in levels 2–5 with a high incidence of extra-nodal spread. Those that are undergoing reoperative thyroid bed surgery for nodal disease in the central neck are very likely to harbor concomitant gross nodal disease in the lateral neck. We encourage a level 2–5 lateral neck dissection or removal of all previously undissected levels when possible for this patient population.
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