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KMID : 0356820190350020011
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Korean Journal of Head & Neck Oncology
2019 Volume.35 No. 2 p.11 ~ p.17
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The Cause of Cervical Lymph Node Recurrence after the Initial Surgery of Papillary Thyroid Carcinoma
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Kim Hyeung-Kyoo
Ha Eun-Ju
Lee In-Hwa
Lee Jeong-Hun
Soh Euy-Young
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Abstract
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Background/Objectives: Papillary thyroid carcinoma (PTC) has generally an indolent character with a good prognosis. However, recurrence remains a major concern for the patients during their lifetime. Despite the slowly progressing character of PTC, recurrence can occur within a short period after initial surgery.
This study aimed to determine the clinical findings and cause of recurrence in patients who underwent re-oper-ative surgery due to neck node recurrence by reviewing the CT (computed tomographic) scan imaging of the recurrence of PTC retrospectively.
Materials & Methods: We reviewed the medical records of patients referred to Ajou University Hospital from January 2002 to January 2018. All patients had re-operative surgery due to neck node recurrence and CT scan results of preoperative evaluation and postoperative follow up. Over this period, 110 patients who underwent re-op-eration due to neck node recurrence with a CT scan were included in our cohort, resulting in a total of 220 re-operations.
Results: The time from initial operation to first re-operation was examined in 110 patients. The median time to re-operation was 28 months, with a range of 4 months to 186 months. Most re-operations (82.7%) occurred within the first five years, 43.6% were in the first two years from the initial surgery. The result of the retrospective CT review showed newly developed cases (21,19.1%), missed diagnosis cases (42,38.2%), real recur cases after surgery (33,30.0%), and remnant lymph nodes (LNs) cases (14,12.7%). We further sub-analyzed 14 cases with remnant LNs.
Reasons for remnant LNs included insufficient operation (N=5) and beyond general surgical extent. (N=9).
Conclusion: Re-operation due to cervical lymph node recurrence is mostly a persistent disease. They included a missed diagnosis and incomplete operation. These finding may reduce the reoperation of cervical lymph node recurrence by accurate preoperative evaluation and complete surgical resection at the initial surgery.
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KEYWORD
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Thyroid cancer papillary, Recurrence, Reoperation
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