Relationship between Initial Thyroid Operation and the Location of Locoregional Recurrence in Papillary Thyroid Cancer: a Single Tertiary Center Experience

Purpose: Locoregional recurrence of papillary thyroid cancer (PTC) after initial thyroid operation is frequent in high-risk patients. However, many studies have reported on risk factors for recurrence without presenting the actual location or patterns of these recurrences. We evaluated the efficacy of initial thyroid operation, which could affect the location of recurrence and prognosis of PTC, thereby requiring reoperation. Methods: This was a retrospective observational cohort study of patients undergoing initial thyroidectomy for PTC with recurrences during follow-up at a single tertiary center. Results: In total, 210 (12.8%) first recurrences and 23 (1.4%) second recurrences were detected after the initial thyroid operation. Recurrences occurred mostly after total thyroidectomy (TT) with central compartment node dissection (CCND) (51.5%) and TT with lateral neck node dissection (LND) (27.5%). The most frequent site of the first locoregional recurrence was the lateral neck node area at the non-operated site of the initial thyroid operation (67.1%). Among patients with a second recurrence, 91.3% had a first recurrence within 5 years after operation. Conclusion: Patients receiving TT with CCND or TT with LND should undergo a thorough examination of lateral neck node area during follow-up, especially at the non-operated lateral neck site. In addition, close observation for a second recurrence is needed for patients with a first recurrence in the early years after the initial operation.