Efficacy of Nodal Dissection for Treatment of Persistent/Recurrent Papillary Thyroid Cancer

<jats:title>Abstract</jats:title><jats:p><jats:bold>Context:</jats:bold> Although commonly performed, data are lacking regarding efficacy and safety of lymph node dissection (LND) for recurrent/persistent papillary thyroid cancer (PTC).</jats:p><jats:p><jats:bold>Objective:</jats:bold> Evaluate the efficacy and morbidity of LND in recurrent/persistent PTC.</jats:p><jats:p><jats:bold>Design:</jats:bold> Retrospective review of central or lateral LND performed for persistent/recurrent PTC between January 2004 and March 2006.</jats:p><jats:p><jats:bold>Setting:</jats:bold> Multidisciplinary thyroid cancer clinic with a single surgeon at an academic medical center.</jats:p><jats:p><jats:bold>Participants:</jats:bold> Seventy‐five patients who underwent 79 LND for persistent/residual PTC. Safety analysis included all 79 resections. Exclusion criteria for the efficacy analysis were factors prohibiting evaluation of thyroglobulin (Tg) response. Forty‐one resections were included in the efficacy analysis.</jats:p><jats:p><jats:bold>Intervention:</jats:bold> Selective LND per standard of care.</jats:p><jats:p><jats:bold>Main Outcome Measure:</jats:bold> Primary outcome was the Tg response to LND. Secondary outcomes were surgical complications.</jats:p><jats:p><jats:bold>Results:</jats:bold> Thirty‐nine of the 41 evaluable resections also had Tg data allowing classification of Tg response. Of 39 classifiable resections, 16 (41%) resulted in undetectable postoperative stimulated Tg levels. An additional 12 resections resulted in significant (≥50%) reductions in suppressed or stimulated Tg levels for an overall improvement rate of 72%. Of all 79 resections, 25 (32%) resulted in minor and 7 (9%) resulted in major complications.</jats:p><jats:p><jats:bold>Conclusions:</jats:bold> LND for persistent/recurrent PTC is a relatively safe procedure in experienced hands. It can lead to an undetectable Tg in 41% of cases and produce a major Tg reduction in an additional 31%. Its efficacy in short‐term follow‐up is comparable with that reported for I‐131, and it should be considered in the management of persistent/recurrent PTC.</jats:p>