The Value of Central Neck Exploration in Reoperation for Recurrent Papillary Thyroid Carcinoma

ABSTRACT

PURPOSE: Central neck recurrence in papillary thyroid cancer patients is critical because it is closely related to mortality. We examined value of the central neck exploration in reoperation for recurrent papillary cancer. METHODS: 70 recurrent papillary cancer patients who underwent reoperation from Jan 1996 to July 2000 were reviewed retrospectively. The patients were divided into 3 groups lateral neck recurrence group (group L, 31 cases), lateral neck and central neck combined recurrence group (group LC, 19 cases), and central neck recurrence group (guoup C, 20 cases). In the 19 cases of group LC, bilateral paratracheal exploration was performed in 10 cases and unilateral paratracheal exploration was completed in 9 cases. Among these, 5 paratracheal areas were negative according to preoperative study and were explored blindly. The remission (serum thyroglobulin suppression) rate of each group following reoperation and the recurrence patterns were examined.

RESULTS:

The remission rate of group L, group LC, group C following reoperation were 46%, 47%, and 65% respectively and the overall average remission rate was 52%. The remission rate of the bilateral paratracheal exploration cases and the unilateral paratracheal exploration cases in group LC were 56% and 38% respectively. Among the 10 bilateral paratracheal exploration cases, 8 recurrent lesions were seen in the primary tumor side paratracheal area and 2 recurrent lesions were observed in the contralateral remnant thyroid or lymph node. Among the 5 paratracheal areas explored blindly, 3 paratracheal areas were recurrence positive.

CONCLUSION:

Careful preoperative evaluation of the central neck is recommended and full exploration of the central neck should be considered if the scarring change is not so severe.