Prognostic Factors in Patients with Initial Low- and Intermediate-Risk Papillary Thyroid Carcinoma Who Undergo Revision Surgery Including the Central Neck Compartment

Background: Papillary thyroid carcinoma (PTC) carries an overall excellent prognosis; however, up to 30% of patients experience locoregional persistent or recurrent disease. Management of central compartment recurrent/persistent disease remains challenging, as revision surgery is associated with increased morbidity. To date, no study has specifically evaluated the prognostic factors of outcomes after revision surgery that included central neck compartments in patients initially classified as low or intermediate risk of recurrence. Methods: We conducted a multicenter retrospective study of 86 patients who underwent reoperation for either recurrent or persistent central neck PTC in three French centers between 2000 and 2024. The primary endpoint was therapeutic response at the time of the patients’ last follow-up. Secondary endpoints included postoperative morbidity, mortality, and distant metastasis. Results: 49/86 patients (57%), with a median follow-up of 6 years, achieved a complete response (CR) after reoperation. Men aged 55 years and over with a recurrent/persistent central neck lesion >15 mm were associated with an incomplete response ( p = 0.044) in univariate analysis. Twenty-six of 86 (30%) patients developed a second structural recurrence after reoperation; a recurrence/persistence size >30 mm was associated with an increased risk of subsequent recurrence (hazard ratio: 3.68; [confidence interval: 1.34–10.08]; p = 0.011). Postoperative persistent complications included recurrent laryngeal nerve palsy in 5.8% of cases, half of which were due to oncologic reasons, and 3.5% resulted from permanent hypoparathyroidism. Conclusions: Reoperation for recurrent/persistent central neck disease in PTC leads to a CR in nearly two-thirds of patients but carries significant morbidity. Lesion size at the first reoperation appears to be a major prognostic factor. These findings support a cautious and individualized surgical approach to optimize outcomes while minimizing risks.