Endocrine Head and Neck Surgery
at the Stanford Head and Neck Center
Recurrent Thyroid Cancer & Revision Surgery
When there is evidence of recurrent thyroid cancer with lymph node metastases, the treatment is often surgical. Thyroid cancer surgery presents certain unique challenges. Reoperation or revision surgery for thyroid cancer presents even greater challenges, due to scarring and anatomical distortion from previous surgery. Revision neck surgery has been associated with higher rates of complication, including recurrent laryngeal nerve paralysis (with a potential impact on voice, swallowing and breathing) and parathyroid insufficiency (with an impact on calcium metabolism), as compared to first time surgery for thyroid cancer. Nevertheless, in experienced hands, excellent outcomes can be achieved. Revision surgery for thyroid cancer is an area of specific expertise for surgeons in the Endocrine Head and Neck Surgery Program at Stanford. 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, extensive knowledge of parathyroid gland and recurrent laryngeal nerve anatomy, skill in neck ultrasonography, as well as expertise in the management of surrounding cancerous lymph nodes (nodal metastases), physicians in the Endocrine Head and Neck Surgery/ Thyroid and Parathyroid Surgery Program at Stanford 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 a review of prior treatment. This information is then correlated with a full physical examination of the head and neck region, updated laryngoscopy (examination of the voice box and vocal cords) and high-resolution ultrasound. Surgeons in the Endocrine Head and Neck Surgery/ Thyroid and Parathyroid Surgery Program at Stanford consider voice evaluation and preservation to be of paramount importance and priority. We take a collaborative approach in consultation with the patient’s medical endocrinologist, as well as sometimes with multidisciplinary experts at the Stanford Thyroid Tumor Board, help to shape a surgical plan.