Risk Factors for Re-recurrence After First Reoperative Surgery for Locoregional Recurrent/Persistent Papillary...

Papillary thyroid carcinoma (PTC) is generally an indolent tumor indicative of favorable prognosis. However, post-treatment recurrences may be problematic, and management strategies for recurrent disease have not been established. This study investigated risk factors associated with re-recurrence of PTC after reoperative surgery.

This study included 151 patients with pathologically confirmed recurrent/persistent PTC who underwent reoperation. Clinical factors, operative and pathologic findings, serum thyroglobulin levels, postoperative complications, and recurrences were examined. Univariate and multivariate analyses were performed to identify factors associated with re-recurrence-free survival (RFS) after reoperative surgery.

Recurrent tumors were found in thyroid remnants or previous resection bed (n=28), central nodes (n=48), and lateral neck nodes (n=102). Biochemical complete remission (stimulated thyroglobulin<1 ng/mL) was achieved in 69 (51.5%) patients after reoperative surgery. Permanent vocal fold paralysis and hypoparathyroidism developed in 6 (4.1%) and 4 (2.8%) patients, respectively. Vocal fold paralysis occurred primarily due to intentional nerve resection following tumor invasion. During a median follow-up of 57.5 months, 41 (27.2%) patients had re-recurrences. Univariate analyses showed that extranodal extension (p=0.028), recurrent laryngeal nerve invasion (p=0.037), as well as stimulated (p=0.001) and unstimulated (p=0.015) serum thyroglobulin were significant predictors of RFS. Multivariate analyses showed that postoperative biochemical remission independently predicted RFS (p=0.014).

Postoperative thyroglobulin after reoperative surgery predicted re-recurrence. Careful follow-up of these patients after reoperation is recommended.