Cirugía Radioguiada en Recidivas de Carcinoma Papilar de Tiroides: Serie de Casos ROLL en recidivas tiroideas

Cirugía Radioguiada en Recidivas de Carcinoma Papilar de Tiroides:
Serie de Casos ROLL en recidivas tiroideas

Radioguided surgery in papillarythyroid carcinoma recurrences:
case series ROLL in Thyroid Recurrences

Irene Grao Torrente*, Tamara Díaz Vico*/**, Silvia Sánchez Infante-Carriche*s, Manuel Durán Poveda*/**

* Servicio de Cirugía General,
     Hospital Universitario Rey Juan Carlos, Móstoles, Madrid
**  Departamento de Especialidades Médicas y Salud Pública,
      Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, España

DOI: https://doi.org/10.14679/5170

Resumen:

Introducción: El carcinoma papilar de tiroides (CPT), pese a su buen pronóstico global, puede presentar recidivas locorregionales en hasta un 30% de los pacientes. Estas suponen un reto quirúrgico debido a la fibrosis postoperatoria y a la proximidad de estructuras críticas. La técnica ROLL (Radioguided Occult Lesion Localization) se ha introducido en cirugía endocrina como herramienta para mejorar la precisión y facilitar este tipo de reintervenciones.
Material y métodos: Se presenta una serie de 13 pacientes con recidiva cervical de CPT tratados mediante cirugía radioguiada con ROLL en el Hospital Universitario Rey Juan Carlos entre 2019 y 2024.
Resultados: La cohorte incluyó 9 mujeres (69,2%) y 4 varones (30,8%), con una edad media de 54,3 años (Rango 29-81). Todos habían sido sometidos a tiroidectomía total y al menos a una dosis de radioyodo. El ROLL se aplicó en segundas o terceras cirugías, con marcaje de lesiones en el lecho tiroideo (3 casos, 23.1%), el compartimento central (4 casos, 30.8%) y/o la región laterocervical (6 casos, 46.1%). En 9 pacientes se asoció algún tipo de linfadenectomía. La tiroglobulina (Tg) sérica descendió en 12 pacientes y se mantuvo estable en uno. No se registraron complicaciones mayores (Clavien-Dindo ≥ III).
Conclusiones: La cirugía radioguiada mediante ROLL constituye una estrategia eficaz y segura para el tratamiento de recidivas cervicales de CPT, especialmente en el contexto de reintervenciones. Su implementación facilita la localización precisa de la enfermedad, permitiendo optimizar los resultados oncológicos y reducir la morbilidad quirúrgica.
Palabras Clave: Carcinoma papilar de tiroides; ROLL; cirugía radioguiada; recidiva cervical; reintervención.

Abstract:

Introduction: Papillary thyroid carcinoma (PTC), despite its generally favorable prognosis, may present locoregional recurrences in up to 30% of patients. These represent a surgical challenge due to postoperative fibrosis and the proximity of critical structures. The ROLL technique (Radioguided Occult Lesion Localization) has been introduced in endocrine surgery as a tool to improve precision and facilitate such reoperations.
Materials and Methods: We present a series of 13 patients with cervical recurrence of PTC treated with ROLL-radioguided surgery at the Rey Juan Carlos University Hospital between 2019 and 2024.
Results: The cohort included 9 women (62.9%) and 4 men (30.8%), with a mean age of 54.3 years. All patients had previously undergone total thyroidectomy and at least one dose of radioiodine. ROLL was applied in second or third surgeries, targeting lesions in the thyroid bed (3 cases, 23.1%), central compartment (4 cases, 30.8%), and lateral neck (6 cases, 46.1%). Lymphadenectomy was performed in 9 patients (69.2%). Serum thyroglobulin (Tg) levels decreased in 12 patients (92.3%) and remained stable in one (7.7%). No major complications were observed (Clavien-Dindo ≥ III).
Conclusions: ROLL-guided surgery is a safe and effective strategy for the management of cervical recurrences of PTC, particularly in reoperative settings. Its implementation enables precise localization of recurrent disease, potentially optimizing oncologic outcomes while reducing surgical morbidity.

Key words: Papillary thyroid carcinoma; ROLL; radioguided surgery; cervical recurrence; reoperation.

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