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Efficacy of Nodal Dissection for Treatment of Persistent/Recurrent Papillary Thyroid Cancer

Authors

  • Kathryn G. Schuff MD,

    1. Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health and Science University, Portland, Oregon, U.S.A.
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  • Stephen M. Weber MD, PhD,

    1. Department of Otolaryngology and Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A.
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  • Babak Givi MD,

    1. Department of Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A.
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  • Mary H. Samuels MD,

    1. Division of Endocrinology, Diabetes and Clinical Nutrition, Oregon Health and Science University, Portland, Oregon, U.S.A.
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  • Peter E. Andersen MD,

    1. Department of Otolaryngology and Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A.
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  • James I. Cohen MD, PhD

    Corresponding author
    1. Department of Otolaryngology and Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, U.S.A.
    • Dr. James Cohen, Department of Otolaryngology and Head and Neck Surgery, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239
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  • s.m.w. and k.g.s. contributed equally to the creation of this paper.

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.

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