Recurrence in regional lymph nodes after total thyroidectomy and neck dissection in patients with papillary thyroid cancer

Summary Background We investigated the risk factors of the regional lymph node (LN) recurrence in papillary thyroid cancer (PTC) patients underwent thyroidectomy and neck dissection according to the clinicopathologic features, preoperative clinical nodal status and the recurrence in previously dissected or undissected compartment of the neck. Methods A retrospective analysis was performed on 297 patients who underwent total thyroidectomy and LN dissection between 2004 and 2010. Patients with and without regional recurrence were compared by the various clinicopathological factors. Recurrence-free survival rates were estimated by the Kaplan–Meier and Cox regression method. Results With a median follow-up of 53 months, 22 (7.4%) patients developed regional LN recurrence. Initial LN metastasis and tumor size ⩾1 cm were independent predictive factors for regional recurrence. In patients without preoperative clinical LN, Tumor size ⩾1 cm and extrathyroidal extension were significant risk factors for regional recurrence. In cases with preoperative clinical LN, there was no specific significant factor for recurrence. Tumor size ⩾1 cm, capsular invasion, extrathyroidal extension, and lymphovascular invasion were significant risk factors of regional recurrence in previously dissected compartments. Tumor size ⩾1 cm and extrathyroidal extension were significant predictive factors of regional recurrence in previously undissected compartments. Conclusions Tumor size and LN metastasis were independent predictors of regional LN recurrence in PTC patients after total thyroidectomy and central neck dissection. Patients with tumor size >1 cm or extrathyroidal extension were more likely to have tumor recur both within the previously dissected field as well as the un-dissected compartments.