Salari Behzad, Ren Yin, Kamani Dipti, Randolph Gregory W
Division of Thyroid and Parathyroid Surgery, Department of Otolaryngology, Massachusetts Eye and Ear Infirmary and Harvard Medical School, Boston, Massachusetts, U.S.A.
Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A.
Laryngoscope. 2016 Apr;126(4):1020-5. doi: 10.1002/lary.25796. Epub 2015 Nov 26.
OBJECTIVES/HYPOTHESIS: To evaluate the quantitative biochemical response, recurrence rate, and rate of surgical complications for thyroid cancer revision surgery.
Retrospective review.
This is a single institution analysis of a prospective database of 181 patients undergoing reoperation for local recurrent thyroid cancer by the same surgeon from 2004 to 2013 with intraoperative neural monitoring. Main outcome measures included pathologic findings, surgical complications, effect of reoperation on thyroglobulin (Tg) levels, and recurrence rate. We defined biochemical complete remission as postoperative stimulated Tg of 0.2 ng/mL or less.
Fourteen percent of the patients presented with permanent vocal cord palsy (VCP), and 20% of the patients presented with hypocalcemia prior to surgery. Among them, 70% of the patients underwent first revision surgery; whereas in 30% the surgery represented second or higher revision surgery, with 8% being a third or higher revision. None developed temporary or permanent VCP. Temporary hypocalcemia occurred in 9% of the patients, and permanent hypocalcemia occurred in 4.2%. The rate of cervical node recurrence was 5% at a median follow-up of 3.4 years. There were no disease-specific deaths. Mean preoperative basal Tg was 22.3 ng/mL and mean postoperative Tg was 5.7 ng/mL, a decline of 74% (P = 0.023, paired t test). Biochemical complete remission was achieved in 58% of all revision cases.
Reoperative neural monitored surgery for recurrent thyroid cancer is a safe and effective procedure with limited morbidity in experienced hands, even in the setting of multiple prior revision surgeries and existing comorbidities such as VCP and hypocalcemia.
目的/假设：评估甲状腺癌翻修手术的定量生化反应、复发率及手术并发症发生率。
回顾性研究。
这是一项单机构分析，对2004年至2013年期间由同一位外科医生对181例局部复发性甲状腺癌患者进行再次手术并术中进行神经监测的前瞻性数据库进行分析。主要观察指标包括病理结果、手术并发症、再次手术对甲状腺球蛋白（Tg）水平的影响及复发率。我们将生化完全缓解定义为术后刺激Tg≤0.2 ng/mL。
14%的患者出现永久性声带麻痹（VCP），20%的患者术前出现低钙血症。其中，70%的患者接受首次翻修手术；30%的患者接受二次或更高次翻修手术，8%为三次或更高次翻修。均未出现暂时性或永久性VCP。9%的患者出现暂时性低钙血症，4.2%的患者出现永久性低钙血症。中位随访3.4年时，颈部淋巴结复发率为5%。无疾病特异性死亡。术前基础Tg均值为22.3 ng/mL，术后Tg均值为5.7 ng/mL，下降74%（配对t检验，P = 0.023）。所有翻修病例中58%实现生化完全缓解。
对于复发性甲状腺癌，再次手术并进行神经监测是一种安全有效的手术，在经验丰富的医生手中发病率有限，即使是在多次既往翻修手术及存在如VCP和低钙血症等合并症的情况下。
4级。
