Thermal ablation vs. conventional neck dissection for recurrent low-burden lymph node metastasis in thyroid cancer: a dual-center retrospective cohort study.

OBJECTIVE

To compare ultrasound-guided thermal ablation (TA) with conventional neck dissection (CND) for recurrent low-burden lymph node metastasis (≤3 lesions, <2 cm) in regional recurrences of thyroid papillary carcinoma, and to guide risk-adaptive therapeutic strategies.

METHODS

A dual-center retrospective study (2016-2022) analyzed 230 patients with recurrent lymph node metastasis, stratified into TA (n = 115) and reoperation groups (n = 115). Endpoints included recurrence-free survival, complications, thyroglobulin (Tg) dynamics, quality of life (EORTC QLQ-C30), and healthcare costs.

RESULTS

Oncological Outcomes: No significant difference in 36-month recurrence rates (Log-rank p = 0.54; Bonferroni-corrected p = 1.00).Safety: Similar complication rates (nerve injury, hypocalcemia, hematoma, infection; all p > 0.7).TA Advantages: Shorter operative time, less blood loss, faster recovery, shorter hospital stays, and lower costs. Nearly 50% of TA-treated patients achieved complete lymph node volume reduction (100% VRR) within 36 months.

CONCLUSION

TA demonstrates non-inferior oncological efficacy compared to CND for strictly selected patients with recurrent low-burden lymph node metastasis, offering minimally invasive, risk-adaptive therapeutic strategies with superior procedural efficiency and quality-of-life benefits.