Surgical resection of recurrent differentiated thyroid cancer: patterns, detection, staging, and treatment of 683 patients

Nan Liang; Han Zhang; Chengqiu Sui; Rui Du; Canxiao Li; Jingting Li; Gianlorenzo Dionigi; Daqi Zhang; Hui Sun

doi:10.3389/fendo.2023.1301620

Surgical resection of recurrent differentiated thyroid cancer: patterns, detection, staging, and treatment of 683 patients

Front Endocrinol (Lausanne). 2023 Dec 6:14:1301620. doi: 10.3389/fendo.2023.1301620. eCollection 2023.

Authors

Nan Liang¹, Han Zhang², Chengqiu Sui¹, Rui Du¹, Canxiao Li¹, Jingting Li¹, Gianlorenzo Dionigi³, Daqi Zhang¹, Hui Sun¹

Affiliations

¹ Division of Thyroid Surgery, The China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Surgical Translational Medicine, Jilin Provincial Precision Medicine Laboratory of Molecular Biology and Translational Medicine on Differentiated Thyroid Carcinoma, Changchun, Jilin, China.
² Division of General Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China.
³ Department of Medical Biotechnology and Translational Medicine, Division of General and Endocrine Surgery, Istituto Auxologico Italiano IRCCS, University of Milan, Milan, Italy.

Abstract

Background: Despite improvements in overall survival, the recurrence of differentiated thyroid cancer (DTC) is becoming more common and remains a challenge necessitating accurate reappraisal of the patient. This study aimed to describe the characteristics, reasons, morbidity, and strategies of second operations for DTC.

Methods: This was a retrospective observational study of patients with DTC who underwent a second surgery between June 2008 and June 2021 in the Department of Thyroid Surgery at China-Japanese Union Hospital, Jilin University, P.R. China. All clinical characteristics were recorded, and the analysis was estimated using SPSS.

Results: Second surgeries were detected in 683 patients. The proportion of second operations changed with the update of international guidelines from 2015 (P < 0.001). The true recurrence rate progressively increased from 21.3% to 61.5%. The rate of an "absence of preoperative FNA" or an "absence of intraoperative pathology at first surgery" decreased from 49.8% to 12.7%, while that of a "misdiagnosis of preoperative FNA at second surgery" decreased from 10% to 1.8%. The most common tumor location during the second surgery was the lateral lymph nodes (n = 104, 36.5%), with a median time to relapse of 36 months. Completion of thyroidectomy and lymph node dissection correlated with the second operation.

Conclusion: After 2015, second surgeries were more standardized, the incidence of complications decreased, and real recurrence became the most common reason for a second DTC surgery.

Keywords: morbidity; recurrence; second surgery; surgery; thyroid cancer.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adenocarcinoma, Follicular* / pathology
Carcinoma, Papillary* / pathology
Humans
Neck Dissection
Recurrence
Retrospective Studies
Thyroid Neoplasms* / diagnosis
Thyroid Neoplasms* / pathology
Thyroid Neoplasms* / surgery

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by the Jilin Province Science and Technology Development Program (20210402011GH, YDZJ202201ZYTS112); and the Program of Jilin Provincial Finance Department (2021SCZ23, 2022SCZ09), the project of China-Japan Union Hospital (2023CL01).