Vol.:(0123456789) 1 3 European Archives of Oto-Rhino-Laryngology https://doi.org/10.1007/s00405-018-5239-2 HEAD & NECK Central compartment revision surgery for persistent or recurrent thyroid carcinoma: analysis of survival and complication rate Gabriele Molteni 1  · Marco Bonali 2  · Francesco Mattioli 2  · Michael Ghirelli 2  · Matteo Fermi 2  · Gaetano Ferri 2  · Malagoli Andrea 3  · Livio Presutti 2 Received: 8 October 2018 / Accepted: 6 December 2018 © Springer-Verlag GmbH Germany, part of Springer Nature 2018 Abstract Purpose Locoregional recurrence of thyroid carcinoma is relatively common and reported rate are between 5 and 20%. Cervical nodes are usually involved, especially at the central compartment. The management of recurrent thyroid carcinoma at central compartment still remains challenging because of higher incidence of complication rate. The aim of the study is to evaluate the survival and complications rate after revision surgery. Methods Retrospective cohort study on a group of patients that underwent revision surgery for persistent or recurrent thyroid carcinoma from January 1, 2003 to December 31, 2017. Survival outcomes were calculated using Kaplan–Meier method. Signifcant variables on univariate analysis were subjected to a Cox proportional hazards regression multivariate model. Results Fifty-two patients involved, 22 male (40%) and 30 female (60%). Mean age was 54 years old (range 24–85). Mean follow-up was 79 months, median follow-up was 85 months, with a range between 8 and 153 months. The 5-year overall survival was 90.8% while at 10 years it was 69.8%. The 5-year disease-specifc survival was 93.5%, while at 10 years it dropped to 77.9%. The rate of recurrent laryngeal nerve paralysis and persistent hypocalcemia in our series were 1.3% and 5.9%, respectively. No evidence of thoracic duct, esophageal or laryngeal and tracheal injury was found in this case series. Regarding prognostic factors, univariate and multivariate analysis highlighted as statistically signifcant: the aggressive histological variants, the presence extranodal extension or soft-tissue metastasis. Conclusion The surgical option remains the gold standard in locoregional recurrences of thyroid carcinoma and should be performed by experienced surgeons to reduce postoperative complications. Keywords Thyroid cancer · Nodal metastases · Neck dissection · Central compartment · Complications · Vocal fold palsy · Hypocalcemia Introduction Thyroid cancer, in particular well-diferentiated thyroid types (WDTC), remains the most frequent endocrine tumor, with an annual incidence of 1–4 per 100,000 individuals. Female sex is prevalent and the median time of diagnosis is about 50 years [1]. Thyroid carcinoma have an excellent prognosis, but it is less favorable when the disease recurs after primary treat- ment [2, 3]. Local or regional recurrence occurs in 5–20% of patients and the most common localization of metastases is represented by the cervical nodes, even if in 10% of cases it might determine distant metastases, especially in the lungs and bones [4, 5]. The early diagnosis of recurrence, in par- ticular the cervical ones, improves the survival rate, reduces the possible complications and allows to choose the best * Michael Ghirelli michael.ghirelli@gmail.com 1 Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Verona, AOUI Borgo Trento, Piazzale Aristide Stefani, 1, 37126 Verona, Italy 2 Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Largo del Pozzo, 71, 41125 Modena, Italy 3 Department of Medical and Surgical Sciences for Children & Adults, Infectious Disease Clinic, University of Modena and Reggio Emilia, Modena, Italy