On their journey to get rid of thyroid cancer, patients often come across a situation where they keep hearing about the necessity of “two or even three more surgeries” besides the one they have already had. This makes many patients wonder why thyroid cancer treatment requires multiple surgeries? In reality, it is not “wrong” as conceived but is a result of a combination of factors that are beyond human control. The main reason is the doctor’s deepest concern in accurate disease control and lowering the chances of reappearance.
I. Properties of the tumor itself: Some thyroid cancers are present “occult” and “aggressive”
Not all thyroid cancers are “mild”, partial types or stages of thyroid cancer have such properties as to increase reoperation probability.
In terms of tumor staging, one of the most important reasons for re-surgery is advanced thyroid cancer (e.g., locally advanced or with regional lymph node metastasis). This tumor, at the time of the first diagnosis, might have surpassed the thyroid gland, invaded the surrounding tissues, such as the trachea, esophagus, recurrent laryngeal nerve, etc., or lymph nodes that have metastasized to the neck. Since during the first surgery, the physician must ensure that the performance of tumor removal and the maintenance of organ function are balanced, it may not be possible to remove all the tissues that have been invaded or lymph nodes that have metastasized in one go completely, and to further reduce the risk of recurrence, subsequent re-surgery will be necessary to re-empt the removal of residual lesions.
In another case, some small “occult” cancers of the thyroid gland may also cause reoperation. This tumor is generally less than 1 cm in diameter and can be difficult to detect in the first preoperative examination (e.g., ultrasound, CT, etc.) due to its small size and hidden location (e.g., deep in the thyroid gland or hidden by other tissues), resulting in it not having been removed in the first surgery. These tiny cancers gradually emerge during regular postoperative visits, and to avoid their further growth or metastasis, the doctor will recommend second surgery.
2. Factors related to the first surgery: there is “deviation in the scope of surgery or pathological assessment”
Factors such as the first surgical scope and the results of the postoperative pathological evaluation may also be the main reasons for subsequent re-surgery.
Concerning the scope of the surgery, in some instances, the range of the initial operation might be too small as a result of insufficient judgment on the malignancy and invasion scope of the tumor at that time, or of the consideration of preserving thyroid function due to which the surgical scope was too small. For instance, only thyroid lobectomy is done, and further postoperative examination shows that the tumor is multifocal with invasion of the extra-thyroid tissue. At this time to achieve more thorough therapeutic effects and reduction of the recurrence rate, merely “resurgery is necessary to increase the surgical scope, such as removing the rest of the thyroid tissue or even clearing lymph nodes in the neck, etc.”.
The results of postoperative pathological evaluation are equally important. If the postoperative pathology report indicates that the tumor has high-risk factors, such as the tumor is rupturing through the thyroid capsule, is invading blood vessels or nerves, and the pathological type is undifferentiated cancer or poorly differentiated cancer, these conditions mean that the risk of tumor recurrence is higher. The doctor usually suggests the additional surgery to remove the cancer cells that may still be there and at the same time combine with the later comprehensive treatment like radioactive iodine treatment to cause better therapeutic effects and improve the prognosis of the patient for this kind of patient.
3. Problems found during postoperative monitoring: tumor recurrence or metastasis needs to be dealt with promptly
Even if the scope of the first operation is adequate and the postoperative pathological evaluation does not show any high-risk factors, tumor recurrence or metastasis may still be found during long-term postoperative follow-up monitoring of patients, and at this time, re-surgical intervention is required.
Recurrence of thyroid cancer postoperatively may happen at different places, for example in the thyroid bed area (that is, the area left after the first surgical removal of the thyroid gland), or in the cervical lymph nodes, and rarely, the cancer may also be spreading to organs such as the lungs and bones. When these recurrent or metastatic lesions are detected by examination such as ultrasound, CT, and radioiodine whole-body scan, if the lesions are localized and can be removed surgically, the doctor usually recommends re-surgery to clear the lesions to control the progression and avoid further tumor spread.
For instance, when some patients undergo regular postoperative ultrasound examinations and discover that the lymph nodes in the neck are swollen and the puncture biopsy confirms the metastasis of thyroid cancer. At this time, cervical lymph node dissection is required to remove the metastatic lymph nodes and prevent the cancer cells from spreading further to other parts.
Doctor epilogue
The necessity for thyroid cancer patients to undergo “two or even three” surgeries does not mean that the disease is too severe to be controlled, but that the doctor makes professional decisions based on the patient’s specific condition (tumor characteristics, stage, pathological type), first surgery, and postoperative monitoring results to achieve a more thorough therapeutic effect, lower the risk of recurrence and improve the patient’s long-term prognosis. Therefore, patients should not be overly panicked or resistant when faced with recommendations for reoperation, should communicate fully with the attending physician in a timely manner, learn more about the necessity of reoperation, surgical methods, risks, and postoperative recovery, and actively cooperate with the physician in the treatment. At the same time, regular follow-up and monitoring must be carried out according to the doctor’s advice after surgery so that early detection and early treatment can be achieved for better management of the condition and improvement of the quality of life.
Disclaimer: The following image/content has been generated by an Artificial Intelligence model and is not a photograph or a traditional human creation.
“Dr. Puneet Girdhar, currently serves as the Director of Orthopedic Spine Surgery at BLK Centre for Orthopaedics, Joint Reconstruction & Spine Surgery at BLK Super Speciality Hospital in New Delhi. With extensive experience, Best Orthopedic surgeon in Delhi, Dr. Girdhar specializes in microendodiscectomies, minimally invasive spinal decompressions and fusions, artificial disc replacements, and deformity correction in the cervical, thoracic, and lumbar spine. He expertly treats a broad range of spinal conditions, including congenital, degenerative, neoplastic, and traumatic.”
