Causes for reoperation of papillary thyroid carcinoma: analysis of 279 cases in a single-center of Yunnan province
Objective: To investigate reasons for reoperation of papillary thyroid carcinoma (PTC) patients and the influential factors. Methods: The clinical data of 279 PTC patients undergoing reoperation from January 2007 to June 2016 were retrospectively analyzed. Results: Of the 297 patients, thyroid remnant cancer recurrence occurred in 156 cases (55.9%) and lymph node metastases occurred in 215 cases (77.1%), and the latter included central lymph node metastasis in 135 cases (48.4%) and lateral lymph node metastasis in 151 cases (54.1%). Statistical analyses showed that female gender and age≥45 years were independent risk factors for thyroid remnant cancer recurrence (both P<0.05); no central lymph node dissection (CND) and initial operation performed at a county-level hospital were independent risk factors for central lymph node metastasis (both P<0.05); male gender and total/near total thyroidectomy (TT/NTT) and CDN used as an initial procedure were independent risk factors for lateral lymph node metastasis (all P<0.05). The median recurrence time from the first operation was 33 months for patients undergoing the first operation at a hospital specialized in thyroid treatments, and they mainly had lateral lymph node metastasis (26.8%) and central lymph node metastasis (42.9%); it was 24 months in a province-level hospital, and they mainly had central lymph node metastasis (32.8%) and thyroid remnant cancer recurrence (29.9%); it was 24 and 12 months in a district- or prefecture-level and county-level hospital, and they mainly had thyroid remnant cancer recurrence of 36.7% and 45.9%, respectively. After reoperation, follow-up was obtained in 158 patients for 10 to 123 month, and of them, one case (0.4%) died, permanent hoarseness occurred in 7 cases (4.4%), permanent hypocalcemia occurred in 19 cases (12.0%), dedifferentiation after 131I therapy occurred in 9 cases (5.7%) and recurrence occurred in 22 cases (13.9%). Conclusion: Non-specialized operation and improper procedure are main reasons for increased postoperative thyroid remnant cancer recurrence and lymph node metastases and thereby reoperation in PTC. Lobectomy or TT/NTT plus ipsilateral or bilateral CND and/or combined with LND may effectively reduce the recurrence rates. The incidences of permanent surgical complications and dedifferentiation are higher after reoperation, so appropriate treatment should be taken in the initial treatment to reduce the risk of recurrence.