Molteni Gabriele, Bonali Marco, Mattioli Francesco, Ghirelli Michael, Fermi Matteo, Ferri Gaetano, Andrea Malagoli, Presutti Livio
Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Verona, AOUI Borgo Trento, Piazzale Aristide Stefani, 1, 37126, Verona, Italy.
Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Largo del Pozzo, 71, 41125, Modena, Italy.
Eur Arch Otorhinolaryngol. 2019 Feb;276(2):551-557. doi: 10.1007/s00405-018-5239-2. Epub 2018 Dec 10.
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.
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.
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.
The surgical option remains the gold standard in locoregional recurrences of thyroid carcinoma and should be performed by experienced surgeons to reduce postoperative complications.
甲状腺癌局部区域复发相对常见，报道的复发率在5%至20%之间。颈部淋巴结通常受累，尤其是中央区。由于并发症发生率较高，中央区复发性甲状腺癌的治疗仍然具有挑战性。本研究的目的是评估翻修手术后的生存率和并发症发生率。
对2003年1月1日至2017年12月31日期间因持续性或复发性甲状腺癌接受翻修手术的一组患者进行回顾性队列研究。使用Kaplan-Meier方法计算生存结果。单因素分析中有显著意义的变量纳入Cox比例风险回归多变量模型。
共纳入52例患者，其中男性22例（40%），女性30例（60%）。平均年龄54岁（范围24 - 85岁）。平均随访79个月，中位随访85个月，范围为8至153个月。5年总生存率为90.8%，10年时为69.8%。5年疾病特异性生存率为93.5%，10年时降至77.9%。我们系列中喉返神经麻痹和持续性低钙血症的发生率分别为1.3%和5.9%。本病例系列中未发现胸导管、食管或喉及气管损伤的证据。关于预后因素，单因素和多因素分析均显示具有统计学意义的因素为：侵袭性组织学变异、存在结外扩展或软组织转移。
手术仍是甲状腺癌局部区域复发的金标准，应由经验丰富的外科医生进行手术以减少术后并发症。
