[Surgical treatment of recurrent thyroid carcinoma after primary resection]

Twenty-six patients who underwent the second operation for recurrent thyroid carcinoma were reviewed. 1) Three surgical interventions; dissection of local lymph nodes, modified neck dissection and extended neck dissection, for the patients with recurrent thyroid carcinoma were performed. Among these patients, recurrence of thyroid carcinoma occurred again in 14 (74%) of 19 patients with dissection of local lymph nodes, 15 (63%) of 24 with modified neck dissection, 2 (22%) of 9 with extended neck dissection. Patients with extended neck dissection had significantly less local recurrence than those with other procedures (p < 0.05). 2) Lymph node recurrence on the resected area occurred in 11 (73%) of 14 patients with dissection of local lymph nodes. Ten (67%) of 15 patients with modified neck dissection had recurrence beyond the dissected area. 3) In well differentiated carcinoma, there was recurrence in 5 (62%) of 8 patients with dissection of local lymph nodes, and in 4 (31%) of 13 with modified neck dissection. In contrast, in poorly differentiated carcinoma, we found recurrence in 8 (89%) of 9, and 10 (100%) of 10, respectively. However, in only one (20%) patient with extended neck dissection, recurrence occurred. We conclude that extended neck dissection should be the procedure of choice in patients with recurrent thyroid cancer whenever feasible.