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Central Compartment Reoperation for Recurrent/Persistent Differentiated Thyroid Cancer: Patterns of Recurrence, Morbidity, and Prediction of Postoperative Hypocalcemia

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Incidence rates of hypoparathyroidism and vocal cord paralysis are high following central compartment reoperation, but few prospective studies have assessed morbidities and factors predictive of hypocalcemia after reoperation. We investigated recurrence patterns, morbidity, and factors predictive of postoperative hypocalcemia in patients undergoing central compartment reoperation for recurrent/persistent differentiated thyroid cancer (DTC).

Methods

We prospectively evaluated 45 consecutive patients with recurrent/persistent DTC. Thyroid remnants or recurrent cancers were removed in 16 patients, the unilateral or bilateral central compartment was cleared in all patients, and the lateral compartment on the diseased side was comprehensively removed from 24 patients. Recurrence patterns were assessed histopathologically, morbidities were monitored, and serum concentrations of calcium and intact parathyroid hormone (iPTH) were measured in all patients.

Results

Eleven patients (24.4%) had tumor invasion into the recurrent laryngeal nerve and/or the tracheoesophagus. Central nodal involvement occurred frequently (86.7%), and the ipsilateral jugular nodes of the lateral compartment were frequently involved. Temporary and permanent vocal cord paralysis developed in 10 (22.2%) and 8 (17.8%) patients, respectively, due primarily to intentional nerve resection following tumor invasion. Of 41 patients without preoperative hypoparathyroidism, 21 (46.3%) had temporary and 2 (4.9%) had permanent hypocalcemia. Multivariate analysis showed that bilateral central compartment dissection and low iPTH levels (<12.0 pg/ml) were independent predictors of postoperative hypocalcemia.

Conclusions

Most patients with recurrent/persistent DTC harbor lesions in the central compartment. Central compartment reoperation may lead to high rates of morbidity, including hypoparathyroidism, which can be predicted by surgical extent and low serum iPTH levels.

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Authors and Affiliations

  1. Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Jong-Lyel Roh MD

  2. Departments of Pathology, Chungnam National University College of Medicine, Daejeon, Republic of Korea

    Jin-Man Kim MD

  3. Otolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea

    Chan Il Park MD

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  1. Jong-Lyel Roh MD
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  2. Jin-Man Kim MD
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  3. Chan Il Park MD
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Correspondence to Jong-Lyel Roh MD.

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Roh, JL., Kim, JM. & Park, C.I. Central Compartment Reoperation for Recurrent/Persistent Differentiated Thyroid Cancer: Patterns of Recurrence, Morbidity, and Prediction of Postoperative Hypocalcemia. Ann Surg Oncol 18, 1312–1318 (2011). https://doi.org/10.1245/s10434-010-1470-9

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  • DOI: https://doi.org/10.1245/s10434-010-1470-9

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