Discussion about Reasons of Reoperation of Papillary Thyroid Carcinoma_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Jieqing ¹ , WEI Tao ¹ , ZHU Qibo ² , GONG Rixiang ¹ , LI Zhihui ¹ , CHEN Rui ¹ , ZHANG Ming ¹ , FU Binhui ¹ , WANG Lanlan ¹ , ZHU Jingqiang. ¹

1. Department of Thyroid and Breast Surgery， West China Hospital， Sichuan University， Chengdu 610041， Sichuan Province， China;;
2. Department of Endocrine， West China Hospital， Sichuan University， Chengdu 610041， Sichuan Province， China;

Corresponding author：

Keywords：

Papillary thyroid carcinoma; Surgery; Reoperation; Resection extent

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Objective 　To discuss the resection extent of primary surgery for papillary thyroid carcinoma （PTC） based on the analysis of the remaining thyroid gland residue and lymph nodes metastasis.
Methods 　The clinical data of 163 patients with PTC received reoperation from January 2009 to September 2011 in our hospital were analyzed retrospectively.
Results 　There were 24 males and 139 females in these patients. The age was 10-75 years old with （38.22±14.57） years old. Among 131 patients received residual thyroid thyroidectomy，88 patients were below 45 years old，and the cancer residual rate was 60.23% （53/88）；the others were over 45 years old，and the cancer residual rate was 76.74% （33/43），which was no significant difference （P?=?0.062）.The lymph nodes metastasis rate was 77.14% （81/105） in the patients below 45 years old and 81.13%?（43/53） in the patients over 45 years old among 158 patients received cervical lymph nodes dissection，which was no significant difference （P?=?0.958）.The cancer residual rate was 74.36%?（58/78），53.66%?（22/41），50.00%?（6/12），and 0 （0/32） in the patients with the tissue less than one lobe resection，lateral lobe （isthmus） resection，lateral lobe plus opposite side subtotal resection，total or subtotal resection，respectively. The total cancer residual rate was 65.65% （86/131） and the bilateral cancer residual rate was 52.76%?（86/163） after reoperation.79.75%?（130/163） of the patients didn’t received lymph nodes dissection in the primary surgery. The lymph nodes metastasis rate was 71.21%?（94/132） and 80.58% （83/103） in the reoperation patients received central region lymph nodes dissection and cervical lateral lymph nodes dissection, respectively.
Conclusions 　　Multifocus is an obvious character of PTC. Patients over 45 years old have more opportunities of tumor residual than that of the youngers （below 45 years old），but the result was no statistic value. For the most patients with PTC，a smaller resection extent suggests a larger risk for cancer residual，and total thyroidectomy or subtotal thyroidectomy leads to the least possibility for the risk. Cervical lymph node is a major type for its metastasis. Proper lymph nodes dissection is an essential way to reduce recurrence and reoperation. The Revised American Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Differentiated Thyroid Cancer （2009） could be a best choice for therapy of PTC. And it is proposed to take central region lymph nodes dissection during primary surgery.

Citation： LI Jieqing,WEI Tao,ZHU Qibo,GONG Rixiang,LI Zhihui,CHEN Rui,ZHANG Ming,FU Binhui,WANG Lanlan,ZHU Jingqiang.. Discussion about Reasons of Reoperation of Papillary Thyroid Carcinoma. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2012, 19(8): 818-822. doi: Copy

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16.	Podnos YD， Smith D， Wagman LD， et al. The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer.[J]. Am Surg， 2005， 71(9)：731-734.
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19.	Cooper DS， Doherty GM， Haugen BR， et al. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer[J]. Thyroid， 2009， 19(11)：1167-1214.
20.	NCCN Guidelines Version 2. 2011 of Thyroid carcinoma. National Comprehensive Cancer Network [EB/OL]. www.nccn.org.
21.	于文斌，张乃嵩，曾宗渊，等. 甲状腺癌二次手术原发灶的切除范围探讨[J]. 癌症， 2009， 28(6)：652-654.
22.	邵稳喜，章佳新，祝玉祥. 分化型甲状腺癌局部切除术后再手术56例临床分析[J]. 临床误诊误治， 2009， 22(5)：12-13.
23.	艾小明，李胜春，何领，等. 27例甲状腺乳头状癌患者再次手术的原因及手术方式探讨[J]. 海南医学， 2011， (20)：70-73.
24.	Bilimoria KY， Bentrem DJ， Ko CY， et al. Extent of surgery affects survival for papillary thyroid cancer[J]. Ann Surg， 2007， 246(3)：375-381.
25.	Esnaola NF， Cantor SB， Sherman SI， et al. Optimal treatment strategy in patients with papillary thyroid cancer：a decision analysis[J]. Surgery， 2001， 130(6)：921-930.

1. Hawk WA， Hazard JB. The many appearances of papillary carcinoma of the thyroid[J]. Cleve Clin Q， 1976， 43(4)：207-215.
2. Carcangiu ML， Zampi G， Rosai J. Papillary thyroid carcinoma：a study of its many morphologic expressions and clinical correlates[J]. Pathol Annu， 1985， 20 Pt 1：1-44.
3. Tscholl-Ducommun J， Hedinger CE. Papillary thyroid carcinomas. Morphology and prognosis[J]. Virchows Arch A Pathol Anat Histol， 1982， 396(1)：19-39.
4. Russell WO， Ibanez ML， Clark RL， et al. Thyroid carcinoma. Classification， intraglandular dissemination， and clinicopathological study based upon whole organ sections of 80 glands[J]. Cancer， 1963， 16：1425-1460.
5. Katoh R， Sasaki J， Kurihara H， et al. Multiple thyroid involvement (intraglandular metastasis) in papillary thyroid carcinoma. A clinicopathologic study of 105 consecutive patients[J]. Cancer， 1992， 70(6)：1585-1590.
6. Mazeh H， Samet Y， Hochstein D， et al. Multifocality in well-differentiated thyroid carcinomas calls for total thyroidectomy[J]. Am J Surg， 2011， 201(6)：770-775.
7. 林益凯，盛建明，赵文和，等. 多灶性甲状腺乳头状癌168例临床研究[J]. 中华外科杂志， 2009， 47(6)：450-453.
8. Hwang E， Pakdaman MN， Tamilia M， et al. Bilateral papillary thyroid cancer and associated histopathologic findings[J]. J Otolaryngol Head Neck Surg， 2010， 39(3)：284-287.
9. 宋明，陈福进，伍国号，等. 甲状腺癌不规范手术后再手术相关问题的探讨[J]. 中华耳鼻咽喉科杂志， 2004， 39(8)：451-455.
10. 徐伟，唐平章，李正江. 甲状腺癌局部切除术后再手术的探讨[J]. 中华肿瘤杂志， 2002， 24(2)：185-187.
11. Rotstein L. The role of lymphadenectomy in the management of papillary carcinoma of the thyroid[J]. J Surg Oncol， 2009， 99(4)：186-188.
12. Shindo M， Wu JC， Park EE， et al. The importance of central compartment elective lymph node excision in the staging and treatment of papillary thyroid cancer[J]. Arch Otolaryngol Head Neck Surg， 2006， 132(6)：650-654.
13. Ito Y， Jikuzono T， Higashiyama T， et al. Clinical significance of lymph node metastasis of thyroid papillary carcinoma located in one lobe[J]. World J Surg， 2006， 30(10)：1821-1828.
14. Pereira JA， Jimeno J， Miquel J， et al. Nodal yield， morbidity， and recurrence after central neck dissection for papillary thyroid carcinoma[J]. Surgery， 2005， 138(6)：1095-1100.
15. Ito Y， Higashiyama T， Takamura Y， et al. Risk factors for recurrence to the lymph node in papillary thyroid carcinoma patients without preoperatively detectable lateral node metastasis：validity of prophylactic modified radical neck dissection[J]. World J Surg， 2007， 31(11)：2085-2091.
16. Podnos YD， Smith D， Wagman LD， et al. The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer.[J]. Am Surg， 2005， 71(9)：731-734.
17. Zaydfudim V， Feurer ID， Griffin MR， et al. The impact of lymph node involvement on survival in patients with papillary and follicular thyroid carcinoma[J]. Surgery， 2008， 144(6)：1070-1077.
18. Lundgren CI， Hall P， Dickman PW， et al. Clinically significant prognostic factors for differentiated thyroid carcinoma：a population-based， nested case-control study[J]. Cancer， 2006， 106(3)：524-531.
19. Cooper DS， Doherty GM， Haugen BR， et al. American Thyroid Association (ATA) Guidelines Taskforce on Thyroid Nodules and Differentiated Thyroid Cancer. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer[J]. Thyroid， 2009， 19(11)：1167-1214.
20. NCCN Guidelines Version 2. 2011 of Thyroid carcinoma. National Comprehensive Cancer Network [EB/OL]. www.nccn.org.
21. 于文斌，张乃嵩，曾宗渊，等. 甲状腺癌二次手术原发灶的切除范围探讨[J]. 癌症， 2009， 28(6)：652-654.
22. 邵稳喜，章佳新，祝玉祥. 分化型甲状腺癌局部切除术后再手术56例临床分析[J]. 临床误诊误治， 2009， 22(5)：12-13.
23. 艾小明，李胜春，何领，等. 27例甲状腺乳头状癌患者再次手术的原因及手术方式探讨[J]. 海南医学， 2011， (20)：70-73.
24. Bilimoria KY， Bentrem DJ， Ko CY， et al. Extent of surgery affects survival for papillary thyroid cancer[J]. Ann Surg， 2007， 246(3)：375-381.
25. Esnaola NF， Cantor SB， Sherman SI， et al. Optimal treatment strategy in patients with papillary thyroid cancer：a decision analysis[J]. Surgery， 2001， 130(6)：921-930.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Discussion about Reasons of Reoperation of Papillary Thyroid Carcinoma

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