PDF(Pubmed)
Abstract：
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.
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.
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.
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.
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.
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.
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.
摘要：
■尽管总生存率有所改善，分化型甲状腺癌(DTC)的复发变得越来越普遍,仍是一个挑战,需要对患者进行准确的重新评估.本研究旨在描述其特点，原因,发病率，以及DTC的二次操作策略。
这是一项回顾性观察性研究，对2008年6月至2021年6月期间在中国联合医院甲状腺外科接受第二次手术的DTC患者，吉林大学,P.R.中国.记录所有临床特征，并使用SPSS进行分析。
■在683例患者中检测到第二次手术。从2015年开始，随着国际指南的更新，二次手术的比例发生了变化（P<0.001）。真实复发率从21.3％逐渐增加到61.5％。“术前FNA缺失”或“首次手术术中病理缺失”的发生率从49.8%降至12.7%，而“第二次手术术前FNA的误诊”从10%下降到1.8%。在第二次手术中最常见的肿瘤位置是外侧淋巴结（n=104，36.5％），中位复发时间为36个月。甲状腺切除术和淋巴结清扫术的完成与第二次手术相关。
■2015年后，第二次手术更加标准化，并发症的发生率下降，真正的复发成为第二次DTC手术的最常见原因。
这是一项回顾性观察性研究，对2008年6月至2021年6月期间在中国联合医院甲状腺外科接受第二次手术的DTC患者，吉林大学,P.R.中国.记录所有临床特征，并使用SPSS进行分析。
■在683例患者中检测到第二次手术。从2015年开始，随着国际指南的更新，二次手术的比例发生了变化（P<0.001）。真实复发率从21.3％逐渐增加到61.5％。“术前FNA缺失”或“首次手术术中病理缺失”的发生率从49.8%降至12.7%，而“第二次手术术前FNA的误诊”从10%下降到1.8%。在第二次手术中最常见的肿瘤位置是外侧淋巴结（n=104，36.5％），中位复发时间为36个月。甲状腺切除术和淋巴结清扫术的完成与第二次手术相关。
■2015年后，第二次手术更加标准化，并发症的发生率下降，真正的复发成为第二次DTC手术的最常见原因。
