Morbidity and long-term survival in patients with cervical re-exploration for papillary thyroid carcinoma

Abstract Background Papillary thyroid carcinoma (PTC) has a favorable prognosis following one-stage surgical therapy, whereas two-stage resections bear the risk of increased morbidity and possibly impaired prognosis. To further elucidate the value of surgical re-exploration in PTC, a retrospective study was performed. Methods The study involved 187 patients with PTC who underwent total thyroidectomy with central lymph node dissection between 2001 and 2011. The number of two-stage surgeries, the rates of recurrent laryngeal nerve paralysis (RLNP) as well as hypocalcemia, and the long-term survival were assessed. Results Two-stage surgeries were performed in 43%. No statistically significant difference was seen between the one- and two-stage resection groups regarding the rate of RLNP (transient 5.6% vs. 6.3%, permanent 2.6% vs. 0%) nor for hypocalcemia (transient 25.2% vs. 18.8%, permanent 14.0% vs. 22.5%). The 10-year recurrence-free survival was 95.5% and the 10-year disease-specific survival was 98.9% with no difference between groups. Conclusion Even though two-stage surgeries do not lead to a higher incidence of RLNP and hypocalcemia, optimal preoperative and intraoperative diagnostics have to be carried out to reduce the amount of completion surgeries.

II Baerbock et al.: Re-exploration for papillary thyroid carcinoma

Comments to Authors:
The aim of this study was to elucidate the value of surgical re-exploration in patients with PTC, further the impact of two-stage surgery and to determine the factors which had an influence on two-stage surgery as well as morbidity and long-term survival. In this one-center study is shown, that the situation and the surgical therapy of thyroid cancer does not always correspond to the data from the literature. The surgical results in this study are -especially to the group of two-stage surgeries -better than expected. Although the number of included patients is high enough to be convincing is it not for statistical significance. However, the results of all relevant parameters are showing, that in the morbidity and the long-term survival, against the common literature, there is no difference between the one-stage patients and the patients who underwent re-exploration. This is a strong indication for an excellent surgery and well done organization for re-exploration within not more than three days. In the decade 2001 to 2011, when patients of this study underwent surgical therapy of PTC, it was clearly recommended to complete surgical therapy when PTC is diagnosed postoperatively with thyroidectomy and lymphadenectomy of the central compartments 1a and 1b. So there is no doubt to the surgical indication position. The representation of reasons for lack of preoperative diagnosis (PTC) is not unusual but normally situation in thyroid surgery. This paper shows exactly the possibilities to handle this problem and it is discussed what can changed in future. Naturally thyroid surgery in patients with PTC should be performed in one step. But as shown there are a lot of reasons that can prevent reaching this aim. Therefore this is an important study, that shows us the daily reality, the procedure and discussion in this center of thyroid surgery. Here are shown very good results in spite of adversities to perform every patient with PTC in one step.

Reviewer Recommendation Term:
Accept with Minor Revision Overall Reviewer Manuscript Rating: 70 Custom Review Questions Response Is the subject area appropriate for you? 4 Does the title clearly reflect the paper's content? 5 -High/Yes Does the abstract clearly reflect the paper's content? 5 -High/Yes Do the keywords clearly reflect the paper's content? 5 -High/Yes Does the introduction present the problem clearly? 5 -High/Yes Are the results/conclusions justified? 5 -High/Yes How comprehensive and up-to-date is the subject matter presented? 5 -High/Yes How adequate is the data presentation? 4 Are units and terminology used correctly? 4 Is the number of cases adequate? 5 -High/Yes Are the experimental methods/clinical studies adequate? 5 -High/Yes Is the length appropriate in relation to the content? 5 -High/Yes Does the reader get new insights from the article? 3 Please rate the practical significance.
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Comments to Authors:
Page 2 line 1: When quoting the incidence of a disease the underlying population always has to be mentioned. In this case it refers to all patients with thyroid nodules (?) Page 2 line 6: one side instead of on side Material and Methods line 5: all instead of al Page 3: Fisher (was an English scientist) instead of Fischer The paper should be revised by a native English speaker e.g.: " Table I shows the extent of two-stage surgery which was done within three days after initial surgical therapy in most cases" instead of " Table I shows the extent of the two-stage surgery, which was on most cases done within three days after initial surgical therapy" Page 4: an incidental finding instead of an incidentally finding two astage asurgery instead oit the two-stage surgery Page 5: Table 1 Extent instead of Extend 11 of whom instead of of whom 11 patients ...