{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T12:48:32Z","timestamp":1762865312935},"reference-count":16,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2007,6,11]],"date-time":"2007-06-11T00:00:00Z","timestamp":1181520000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Head &amp; Neck"],"published-print":{"date-parts":[[2007,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The aim of this study was to review our experience with reoperative thyroid bed surgery (RTBS) for recurrent\/persistent papillary thyroid cancer (PTC), and present an algorithm for safe and effective RTBS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a retrospective study. Records of 33 consecutive patients who underwent RTBS for recurrent\/persistent PTC in a previously operated thyroid bed, and were operated upon by the senior author (R.P.T.) July 2001 to January 2006 were reviewed. Reports of the pre\u2010 and post\u2010RTBS serum thyroglobulin (TG) levels, the high\u2010resolution thyroid bed ultrasound examination, pre\u2010RTBS FNA cytopathology, as well as the post\u2010RTBS final histopathology were reviewed. Recurrent laryngeal nerve (RLN) monitoring was used for all patients. Reports of the intra\u2010RTBS condition of the RLN and any reported surgical complications were reviewed. In addition, reports of the pre\u2010 and post\u2010RTBS fiberoptic laryngoscopy as well as pre\u2010 and post\u2010RTBS serum calcium levels were reviewed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In our study, 33 consecutive patients underwent RTBS for recurrent\/persistent PTC with or without lateral neck dissection. In 30 patients, recurrent\/persistent PTC was suspected because of rising serum TG levels, interpreted in conjunction with serum anti\u2010TG\u2010antibody titers by the endocrinology service at our institution. Three patients had serum anti\u2010TG antibodies and their disease was detected and FNA confirmed by a regularly scheduled surveillance ultrasound examination. All patients underwent pre\u2010RTBS high\u2010resolution thyroid bed ultrasound examination and FNA for all suspicious masses. All patients had FNA\u2010confirmed PTC in the thyroid bed. All patients had detailed diagrams localizing areas of FNA\u2010confirmed PTC in the thyroid bed provided to the surgeon. In all study patients, post\u2010RTBS histopathologic findings confirmed sites of recurrent\/persistent PTC determined by pre\u2010RTBS US guided FNA. All RLNs (53\/53) that were at risk were successfully identified. In 3 patients, the RLN was electively resected because of the envelopment by a large paratracheal mass or tumor densely adherent to the RLN insertion point at the cricothyroid region. There was no incidence of unexpected RLN injury, permanent hypocalcemia, or any other surgery\u2010related complication. Post\u2010RTBS serum TG levels were significantly decreased or undetectable in most patients (2 patients had concurrent lung metastases), when compared with pre\u2010RTBS levels. No patient exhibited thyroid bed recurrent\/persistent PTC in the post\u2010RTBS period based on semiannual high resolution neck ultrasound examination with a median follow\u2010up of 2 years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Safe and effective RTBS is based on a multidisciplinary approach that enables the identification and localization of recurrent\/persistent PTC. The surgical algorithm for RTBS described, provides a pathway that all endocrine\u2010head and neck surgeons can comfortably utilize to treat this complex and challenging patient population. \u00a9 2007 Wiley Periodicals, Inc. 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