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갑상선 유두암의 일차 수술 후 경부 림프절 재발의 원인

The Cause of Cervical Lymph Node Recurrence after the Initial Surgery of Papillary Thyroid Carcinoma

대한두경부종양학회지 2019년 35권 2호 p.11 ~ 17
김형규 ( Kim Hyeung-Kyoo ) - 아주대학교 의과대학 외과학교실

하은주 ( Ha Eun-Ju ) - 아주대학교 의과대학 영상의학교실
이인화 ( Lee In-Hwa ) - 아주대학교 의과대학 외과학교실
이정훈 ( Lee Jeong-Hun ) - 아주대학교 의과대학 외과학교실
소의영 ( Soh Euy-Young ) - 아주대학교 의과대학 외과학교실

Abstract


Background/Objectives: Papillary thyroid carcinoma (PTC) has generally an indolent character with a good prognosis. However, recurrence remains a major concern for the patients during their lifetime. Despite the slowly progressing character of PTC, recurrence can occur within a short period after initial surgery.
This study aimed to determine the clinical findings and cause of recurrence in patients who underwent re-oper-ative surgery due to neck node recurrence by reviewing the CT (computed tomographic) scan imaging of the recurrence of PTC retrospectively.

Materials & Methods: We reviewed the medical records of patients referred to Ajou University Hospital from January 2002 to January 2018. All patients had re-operative surgery due to neck node recurrence and CT scan results of preoperative evaluation and postoperative follow up. Over this period, 110 patients who underwent re-op-eration due to neck node recurrence with a CT scan were included in our cohort, resulting in a total of 220 re-operations.

Results: The time from initial operation to first re-operation was examined in 110 patients. The median time to re-operation was 28 months, with a range of 4 months to 186 months. Most re-operations (82.7%) occurred within the first five years, 43.6% were in the first two years from the initial surgery. The result of the retrospective CT review showed newly developed cases (21,19.1%), missed diagnosis cases (42,38.2%), real recur cases after surgery (33,30.0%), and remnant lymph nodes (LNs) cases (14,12.7%). We further sub-analyzed 14 cases with remnant LNs.
Reasons for remnant LNs included insufficient operation (N=5) and beyond general surgical extent. (N=9).

Conclusion: Re-operation due to cervical lymph node recurrence is mostly a persistent disease. They included a missed diagnosis and incomplete operation. These finding may reduce the reoperation of cervical lymph node recurrence by accurate preoperative evaluation and complete surgical resection at the initial surgery.

키워드

Thyroid cancer papillary; Recurrence; Reoperation
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