Korean Journal of Head & Neck Oncology (대한두경부종양학회지)

The Korean Society for Head and Neck Oncology (대한두경부종양학회)
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The Cause of Cervical Lymph Node Recurrence after the Initial Surgery of Papillary Thyroid Carcinoma

갑상선 유두암의 일차 수술 후 경부 림프절 재발의 원인

  • Kim, Hyeung Kyoo (Department of Surgery, Ajou University School of Medicine) ;
  • Ha, Eun Ju (Department of Radiology, Ajou University School of Medicine) ;
  • Lee, Inhwa (Department of Surgery, Ajou University School of Medicine) ;
  • Lee, Jeonghun (Department of Surgery, Ajou University School of Medicine) ;
  • Soh, Euy Young (Department of Surgery, Ajou University School of Medicine)
  • 김형규 (아주대학교 의과대학 외과학교실) ;
  • 하은주 (아주대학교 의과대학 영상의학과학교실) ;
  • 이인화 (아주대학교 의과대학 외과학교실) ;
  • 이정훈 (아주대학교 의과대학 외과학교실) ;
  • 소의영 (아주대학교 의과대학 외과학교실)
  • Received : 2019.10.26
  • Accepted : 2019.11.18
  • Published : 2019.11.30
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Abstract

Background/Objectives: Papillary thyroid carcinoma (PTC) has generally an indolent character with a good prognosis. However, recurrence remains a major concern for the patients during their lifetime. Despite the slowly progressing character of PTC, recurrence can occur within a short period after initial surgery. This study aimed to determine the clinical findings and cause of recurrence in patients who underwent re-operative surgery due to neck node recurrence by reviewing the CT (computed tomographic) scan imaging of the recurrence of PTC retrospectively. Materials & Methods: We reviewed the medical records of patients referred to Ajou University Hospital from January 2002 to January 2018. All patients had re-operative surgery due to neck node recurrence and CT scan results of preoperative evaluation and postoperative follow up. Over this period, 110 patients who underwent re-operation due to neck node recurrence with a CT scan were included in our cohort, resulting in a total of 220 re-operations. Results: The time from initial operation to first re-operation was examined in 110 patients. The median time to re-operation was 28 months, with a range of 4 months to 186 months. Most re-operations (82.7%) occurred within the first five years, 43.6% were in the first two years from the initial surgery. The result of the retrospective CT review showed newly developed cases (21,19.1%), missed diagnosis cases (42,38.2%), real recur cases after surgery (33,30.0%), and remnant lymph nodes (LNs) cases (14,12.7%). We further sub-analyzed 14 cases with remnant LNs. Reasons for remnant LNs included insufficient operation (N=5) and beyond general surgical extent. (N=9). Conclusion: Re-operation due to cervical lymph node recurrence is mostly a persistent disease. They included a missed diagnosis and incomplete operation. These finding may reduce the reoperation of cervical lymph node recurrence by accurate preoperative evaluation and complete surgical resection at the initial surgery.

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References

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