Central compartment revision surgery for persistent or recurrent thyroid carcinoma: analysis of survival and complication rate

• Published in: European archives of oto-rhino-laryngology 2019-02, Vol.276 (2), p.551-557
• Main Authors: Molteni, Gabriele, Bonali, Marco, Mattioli, Francesco, Ghirelli, Michael, Fermi, Matteo, Ferri, Gaetano, Andrea, Malagoli, Presutti, Livio
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Carcinoma, Medullary - mortality; Carcinoma, Medullary - surgery; Carcinoma, Papillary - mortality; Carcinoma, Papillary - surgery; Cohort Studies; Female; Head & Neck; Head and Neck Surgery; Humans; Hypocalcemia - etiology; Male; Medicine; Medicine & Public Health; Middle Aged; Neck Dissection; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - surgery; Neurosurgery; Otorhinolaryngology; Postoperative Complications; Prognosis; Reoperation; Retrospective Studies; Thyroid Neoplasms - mortality; Thyroid Neoplasms - surgery; Thyroidectomy; Vocal Cord Paralysis - etiology; Young Adult
• ISSN: 0937-4477; 1434-4726
• DOI: 10.1007/s00405-018-5239-2

Purpose Locoregional recurrence of thyroid carcinoma is relatively common and reported rate are between 5 and 20%. Cervical nodes are usually involved, especially at the central compartment. The management of recurrent thyroid carcinoma at central compartment still remains challenging because of higher incidence of complication rate. The aim of the study is to evaluate the survival and complications rate after revision surgery. Methods Retrospective cohort study on a group of patients that underwent revision surgery for persistent or recurrent thyroid carcinoma from January 1, 2003 to December 31, 2017. Survival outcomes were calculated using Kaplan–Meier method. Significant variables on univariate analysis were subjected to a Cox proportional hazards regression multivariate model. Results Fifty-two patients involved, 22 male (40%) and 30 female (60%). Mean age was 54 years old (range 24–85). Mean follow-up was 79 months, median follow-up was 85 months, with a range between 8 and 153 months. The 5-year overall survival was 90.8% while at 10 years it was 69.8%. The 5-year disease-specific survival was 93.5%, while at 10 years it dropped to 77.9%. The rate of recurrent laryngeal nerve paralysis and persistent hypocalcemia in our series were 1.3% and 5.9%, respectively. No evidence of thoracic duct, esophageal or laryngeal and tracheal injury was found in this case series. Regarding prognostic factors, univariate and multivariate analysis highlighted as statistically significant: the aggressive histological variants, the presence extranodal extension or soft-tissue metastasis. Conclusion The surgical option remains the gold standard in locoregional recurrences of thyroid carcinoma and should be performed by experienced surgeons to reduce postoperative complications.