Lang Brian Hung-Hin, Lee George C C, Ng Cathy P C, Wong Kai Pun, Wan Koon Yat, Lo Chung-Yau
Department of Surgery, The University of Hong Kong, Hong Kong SAR, China,
World J Surg. 2013 Dec;37(12):2853-9. doi: 10.1007/s00268-013-2202-7.
Although reoperative surgery in the central compartment (RCND) is indicated for bulky or progressive persistent/recurrent papillary thyroid carcinoma (PTC), its associated morbidity and disease outcomes remain unclear. We evaluated RCND outcomes by comparing them with those of patients who underwent primary central neck dissection (CND).
After matching for age, sex, tumor size, and initial tumor stage, the morbidity and outcomes of 50 consecutive patients who underwent RCND were compared with data from 75 patients who underwent primary therapeutic CND during the same period. Matching was performed blind to the morbidity and disease outcome of each patient. A stimulated thyroglobulin (sTg) <2 ng/ml was considered undetectable.
Relative to primary CND, the incidence of extranodal extension (p = 0.010) and size of metastatic lymph nodes (p < 0.001) were significantly greater in the RCND group. Postoperative hypoparathyroidism and vocal cord palsy rates were comparable in the groups. There were two esophageal injuries in the RCND group and none in the primary CND group. The secondary CND group achieved a significantly lower undetectable postablation sTg rate (12.0 vs. 52.0 %, p = 0.001) and worse 10-year disease-free survival (35.6 vs. 91.8 %, p = 0.001) and cancer-specific survival (82.0 vs. 98.5 %, p = 0.001) than the primary CND group.
Although RCND for persistent/recurrent PTC was performed with morbidity comparable to that seen with primary CND, it was associated with some serious complications. Short- and long-term disease control appeared moderate with approximately one-tenth of patients having an undetectable sTg level 6 months after ablation and one-third remaining clinically disease-free after 10 years.
尽管中央区再次手术（RCND）适用于体积较大或进展性持续性/复发性乳头状甲状腺癌（PTC），但其相关的发病率和疾病转归仍不明确。我们通过将RCND的结果与接受初次中央区颈淋巴结清扫术（CND）的患者的结果进行比较，来评估RCND的结果。
在对年龄、性别、肿瘤大小和初始肿瘤分期进行匹配后，将连续50例行RCND的患者的发病率和结果与同期75例行初次治疗性CND的患者的数据进行比较。匹配过程对每位患者的发病率和疾病转归进行盲法操作。刺激甲状腺球蛋白（sTg）<2 ng/ml被视为不可检测到。
相对于初次CND，RCND组的结外侵犯发生率（p = 0.010）和转移性淋巴结大小（p < 0.001）显著更高。两组术后甲状旁腺功能减退和声带麻痹发生率相当。RCND组有2例食管损伤，初次CND组无食管损伤。与初次CND组相比，再次CND组消融后不可检测到sTg的比例显著更低（12.0%对52.0%，p = 0.001），10年无病生存率更差（35.6%对91.8%，p = 0.001），癌症特异性生存率也更差（分别为82.0%和98.5%，p = 0.001）。
尽管持续性/复发性PTC的RCND的发病率与初次CND相当，但它与一些严重并发症相关。短期和长期疾病控制似乎一般，约十分之一的患者在消融后6个月sTg水平不可检测到，三分之一的患者在10年后仍无临床疾病。
