Long term outcomes after repeat lymph node dissections for persistent or recurrent differentiated thyroid cancer

Martin Jose Barrio; Nikita Pozdeyev; Robert C McIntyre Jr; Maria B Albuja-Cruz; Bryan R Haugen; Christopher D Raeburn

doi:10.1016/j.amjsurg.2024.116045

Long term outcomes after repeat lymph node dissections for persistent or recurrent differentiated thyroid cancer

Am J Surg. 2024 Oct 24:239:116045. doi: 10.1016/j.amjsurg.2024.116045. Online ahead of print.

Authors

Martin Jose Barrio¹, Nikita Pozdeyev², Robert C McIntyre Jr¹, Maria B Albuja-Cruz¹, Bryan R Haugen³, Christopher D Raeburn⁴

Affiliations

¹ Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave., C-313 Mail Stop, Aurora, CO, 80045, United States.
² Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, 12801 E. 17th Ave., 7103, Research 1 South, Aurora, CO, 80045, United States; Department of Biomedical Informatics, University of Colorado School of Medicine, 1890 N. Revere Court, Mailstop F600, Aurora, CO, 80045, United States.
³ Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, 12801 E. 17th Ave., 7103, Research 1 South, Aurora, CO, 80045, United States.
⁴ Division of GI, Trauma, and Endocrine Surgery, Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Ave., C-313 Mail Stop, Aurora, CO, 80045, United States. Electronic address: Christopher.raeburn@cuanschutz.edu.

PMID: 39489005
DOI: 10.1016/j.amjsurg.2024.116045

Abstract

Background: The primary treatment for locoregional recurrent/persistent differentiated thyroid cancer (DTC) is repeated lymph node dissection; however, there are limited reports on the safety and long-term efficacy of multiple operations.

Methods: Patients who underwent a cervical lymph node dissection between 1998 and 2022 were included in this study. Demographics, initial thyroid surgery, subsequent lymph node dissections, follow up information, and response to therapy were acquired.

Results: After one, two, three and four re-operations, 112/314 (35.7 %), 16/79 (20.3 %), 3/25 (12 %), and 0/3 (0 %) patients (p < 0.001) had an excellent response, respectively, resulting in a cumulative rate of 41.7 % (131/314). The risk for permanent hypoparathyroidism (2.9 %) or recurrent laryngeal nerve injury (2.2 %) was 5.1 % (14/272). This was higher in patients undergoing re-operative central neck dissection (CNDx) (8.7 %, 10/114) versus those who did not undergo a previous CNDx (2.5 %, 4/158, p < 0.02).

Conclusions: Surgery remains the primary treatment for recurrent/persistent DTC, however, the likelihood of an excellent response decreases with additional operations. The risk of permanent complications is low but is more likely to occur during redo CNDx.

Keywords: Neck dissection; Response to therapy; Thyroid cancer.