PATTERNS OF STRUCTURAL RECURRENCE IN PATIENTS WITH TOTAL THYROIDECTOMY AND CENTRAL COMPARTMENT NECK DISSECTION FOR PAPILLARY THYROID CARCINOMA

AUTHORS:
M. de Miguel-Palacio (Barcelona, Spain) , L. Lorente-Poch (Barcelona, Spain) , K.Q. Qiu (Barcelona, Spain) , M. Arumi-Uria (Barcelona, Spain) , A. Radosevic (Barcelona, Spain) , J. Ares-Vidal (Barcelona, Spain) , J.J. Chillaron-Jordan (Barcelona, Spain) , J. Sancho-Insenser (Barcelona, Spain)
Background:
Defenders of prophylactic central compartment neck dissection for papillary thyroid carcinoma (PTC), claim it would avoid local recurrence on the same compartment, although the pattern of recurrence after total thyroidectomy (TT) and CCND has scarcely been reported. We aimed to assess the pattern of structural loco-regional recurrence after TT plus prophylactic(p-CCND) or therapeutic (t-CCND) CCND in patients with PTC.
Methods:
A unicentric observational study assessing 280 consecutive patients operated for PTC between August/1993 and March/2022. About 98% underwent TT+CCND and only 6 patients underwent hemithyroidectomy+CCND. Among them, 154(55%) received p-CCND, 125(45%) t-CCND and only one patient had TT alone. Lateral neck dissection was additionally performed in 27%. Patients who had initial surgery in another center or had incidental PTC were excluded.
Results:
A total of 23(8.21%) patients developed structural loco-regional recurrence during a follow-up of 89±73(10-322) months. Only one patient(0.3%) had a central compartment recurrence (pretracheal-subistmic). Laterocervical recurrences were ipsilateral in 5 cases(23%) and contralateral in one case after a TT+CCND plus ipsilateral lateral neck dissection. Patients who had loco-regional recurrence were significantly younger (41±12vs.47±14years; P=0.03), had extra-capsular invasion more frequently(14.8%vs.5.9%; p=0.023) and had double number of positive lymphnodes in CCND(5.6±0.9vs.2.9±0.3;P=0.002). Patients who underwent t-CCND developed structural recurrence six times more frequently than patients with p-CCND (14.4% vs.2.6%; P<0.001). Gender, multicentricity, and tumor diameter were not associated with a higher risk for recurrence.
Conclusions:
After CCND loco-regional recurrence is exceptional. Patterns of recurrence differ after performing t-CCND or p-CCND and it seems not to be influenced by other classic risk factors.