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Abstract
Recently, an increase in the number of cases of radioiodine resistance of well-differentiated thyroid cancers (WDTCs) has been noted, which manifests itself in the form of recurrence of the disease at different times after surgical treatment and 131I therapy. Aim of the study was to analyze the clinical and cytomorphological characteristics, as well as the results of surgical treatment of recurrence of radioiodine-resistant metastases of WDTCs, which occurred in patients after radical primary treatment. Material and methods. The design is a clinical retrospective cohort study of 164 patients with WDTCs who developed radioiodine resistance after radical treatment (thyroidectomy, 131I therapy, and suppressive hormone therapy) and underwent reoperation in the volume to remove regional lymph nodes. Results. Patients in whom radioiodine-resistant recurrence of the malignant process was found constituted a group with more aggressive and widespread tumors. Analysis of the primary characteristics of WDTCs showed that in half of the cases (47.0%) the tumor extended beyond the capsule (pT3, pT4a and pT4b), and in 63.4% of patients there were metastases in the lymph nodes of the neck. In 135 cases (82.3%), malignancy was confirmed by cytological examination of the lymph node, and in 29 cases (17.7%), the biopsy was technically complicated and the diagnosis was confirmed by indirect echographic signs of malignancy. Conclusions. The presence of recurrent, lymphogenic local radioiodine-resistant metastases of WDTCs is an incomplete response to previous therapy and reflects the features of cancer biology. Careful analysis of more disease-related factors may reduce the risk of reoperation for localized radioiodine-resistant metastases. Timely implementation of radical dissection of recurrent metastases allowed us to obtain an excellent response in 108 observations (72.0%). A higher efficiency of repeated neck dissections in relation to radioiodine-resistant relapses of WDTCs was shown by a systematic compartmental approach compared to local operations such as berry picking type.
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