Faculty Collaboration Database

Preventable reoperations for persistent and recurrent papillary thyroid carcinoma. Surgery 2004 Dec;136(6):1183-91

Date

01/20/2005

Pubmed ID

15657574

DOI

10.1016/j.surg.2004.06.045

Scopus ID

2-s2.0-10644284969 (requires institutional sign-in at Scopus site)   84 Citations

Abstract

BACKGROUND: Cervical recurrence occurs in up to 25% of patients with papillary thyroid carcinoma (PTC) due either to the aggressive biology of PTC or to inadequate treatment. This retrospective study was designed to determine the frequency of inadequate surgical or medical therapy as a cause of persistent or recurrent PTC.

METHODS: We identified all patients who underwent reoperation for persistent (within 6 months of initial or pre-referral operation) or recurrent (greater than 6 months after initial or pre-referral operation) PTC from 1992 to 2003. Medical records including initial preoperative imaging, operative, and histopathology reports were reviewed. The initial surgical procedure was considered incomplete if all gross neoplasm was not removed or if "node plucking" was performed, and a subsequent recurrence occurred in the same cervical compartment.

RESULTS: Seventy-two consecutive patients underwent reoperation for persistent (17) or recurrent (55) PTC. Of the 17 patients with persistent PTC, reoperation was judged to have been possibly preventable in 14 (82%) due to inadequate preoperative imaging or incomplete initial surgery. Of the 55 patients with recurrent PTC, reoperation was judged to have been possibly preventable due to incomplete initial surgery in 14 (25%). Based on the National Comprehensive Cancer Network guidelines, 33 (46%) of 72 patients with persistent or recurrent PTC received inadequate initial local treatment.

CONCLUSIONS: Reoperation in 28 (39%) of 72 patients with persistent or recurrent PTC was potentially preventable. Accurate preoperative staging and adherence to the suggested National Comprehensive Cancer Network treatment guidelines may minimize the need for cervical reoperation.

Author List

Kouvaraki MA, Lee JE, Shapiro SE, Sherman SI, Evans DB

Author

Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma, Papillary
Adolescent
Adult
Aged
Aged, 80 and over
Combined Modality Therapy
Female
Guideline Adherence
Humans
Male
Medical Errors
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging
Neoplasm, Residual
Reoperation
Retrospective Studies
Thyroid Neoplasms
Thyroidectomy
Treatment Outcome