Recurrent and Revision Surgery

Thyroid cancer presents certain unique challenges in surgery. Revision surgery for thyroid cancer presents even greater challenges, due to scarring and anatomical distortion from previous surgical procedure(s). Revision thyroid surgery has been associated with higher rates of complication, including recurrent laryngeal nerve paralysis (with a potential impact on voice and breathing) and parathyroid insufficiency (with an impact on calcium metabolism), as compared to first time surgery for thyroid cancer. Revision surgery for thyroid cancer is an area of specific expertise for surgeons in the Thyroid Division at Massachusetts Eye and Ear. Such surgery may be necessary, as over time, up to twenty percent of patients with initial thyroid cancer may subsequently develop recurrent disease in the form of neck lymph node metastases. 

With expertise in head and neck surgical oncology and extensive knowledge of parathyroid gland and recurrent laryngeal nerve anatomy, as well as expertise in the management of surrounding cancerous lymph nodes (nodal metastases), physicians in the Division of Thyroid and Parathyroid Surgery at Massachusetts Eye and Ear offer the best care available for these challenging cases. Furthermore, they are joined in this multidisciplinary effort to treat thyroid malignancy by collaborators from the departments of radiology, medical endocrinology, oncology, radiation oncology, pathology and cytopathology, speech and swallowing therapy and laryngology. 

The management of recurrent thyroid cancer begins with the preoperative evaluation. This includes a full physical examination of the head and neck region and of the voice box and vocal cords in an office setting. Physicians in the Division of Thyroid and Parathyroid Surgery have established and popularized a unique methodology for preoperative evaluation of recurrent thyroid cancer management that includes a combination of high-resolution ultrasound and fine cut CT scanning of the neck to make a 3-dimensional map of the thyroid cancer and any lymph node neck metastases. Additionally, the surgeon often formulates a collaborative plan in consultation with the patient’s medical endocrinologist prior to surgery. 

When there is evidence of recurrent thyroid cancer with lymph node metastases, the treatment is often surgical. Surgeons in the Division of Thyroid and Parathyroid Surgery use nerve-monitoring technology that was pioneered at Mass. Eye and Ear to preserve voice function and to prevent postoperative breathing and swallowing issues during these procedures. Intraoperative ultrasound is also available and is used to detect specific lymph node metastases. This is especially important because of scarring and distortion of the surgical field from previous surgery. The surgery is typically performed through the previous incision and involves an overnight stay in the hospital. Because of this expertise and the extremely favorable published outcomes, the Division of Thyroid and Parathyroid Surgery at Mass. Eye and Ear is one of the highest volume centers for such surgery in the United States.

Scientific Resources

Below are articles and studies relating to thyroid cancer revision surgery. They are written for a physician audience but you may find these helpful in your own treatment course. Please contact your physician for questions and concerns.

Dr. Randolph recently published a study of 117 surgeries for recurrent thyroid cancer in patients who underwent a second, third, fourth, fifth, sixth or seventh cancer surgery at Massachusetts Eye and Ear Infirmary. The studied showed a 0% rate of neural complications.

Drs. Lesnik and Randolph published a radiographic algorithm that supports accurate definition of lymph node metastasis for patients with the most common type of thyroid cancer called papillary carcinoma both in primary surgery and revision surgery.

Dr. Randolph has also published on behalf of the American Thyroid Association a review paper outlining the importance of radiographic recognition of macroscopic nodal disease.

Physicians in the Division of Thyroid and Parathyroid Surgery have published an article on evidence based treatment of high-thyroid cancers such as poorly differentiated thyroid cancer.

Drs. Randolph and Kamani of the Thyroid Division have done extensive work on the importance of laryngeal exam prior to thyroid surgery.