Oncology · 2025
Managing the Involved Recurrent Laryngeal Nerve in Thyroid Cancer.
СтатьяНазвание и аннотация: Перевод в очереди
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Soong Tse Kiat, Tang Sarah Shuyun, Lim Yi Xun, Yuan Ngiam Kee, Lee James Wai Kit, Parameswaran Rajeev
Аннотация
BACKGROUND: Recurrent laryngeal nerve (RLN) palsy (RLNP) is not uncommon after thyroid surgery and can be debilitating. This is a retrospective cohort analysis of outcomes in patients with RLNP post-thyroidectomy for differentiated thyroid malignancy.
METHOD: Clinicopathological details as well as outcomes of thyroidectomies for differentiated thyroid cancer in 862 patients performed over a period of 22 years (2001-2023) for nerve palsy were collected. The patients were stratified into two groups based on whether the RLN was amputated or preserved.
RESULTS: Of the 1,520 nerves in 862 patients at risk during thyroidectomy, a total of 71 (8.2%) (20 M:51 F) patients, with a median age of 54 (range: 19-83), suffered RLNP, which was temporary in 14 (1.6%), unilateral in 51 (5.9%), and bilateral in 6 (0.7%) patients. The RLN was amputated in 31 of 62 patients (50%). In 29 of 71 (41%) patients, the nerve was intentionally sacrificed due to gross disease infiltration while the RLN was inadvertently severed during dissection in 2 (3%) patients. Among cases with RLN transection, only five underwent primary repair or ansa cervicalis to RLN anastomosis. The only factor associated with amputation of the RLN was a larger tumour size (40.4 vs. 24.7 mm, p = 0.007). Preservation of voice quality was higher in the shave group in comparison to the amputation group (93.5% vs. 71.0%, p = 0.0426).
CONCLUSION: Preservation of nerve or reconstruction in transectional injuries should be considered where possible to improve voice outcomes except in cases when the laryngotracheal complex is involved.
METHOD: Clinicopathological details as well as outcomes of thyroidectomies for differentiated thyroid cancer in 862 patients performed over a period of 22 years (2001-2023) for nerve palsy were collected. The patients were stratified into two groups based on whether the RLN was amputated or preserved.
RESULTS: Of the 1,520 nerves in 862 patients at risk during thyroidectomy, a total of 71 (8.2%) (20 M:51 F) patients, with a median age of 54 (range: 19-83), suffered RLNP, which was temporary in 14 (1.6%), unilateral in 51 (5.9%), and bilateral in 6 (0.7%) patients. The RLN was amputated in 31 of 62 patients (50%). In 29 of 71 (41%) patients, the nerve was intentionally sacrificed due to gross disease infiltration while the RLN was inadvertently severed during dissection in 2 (3%) patients. Among cases with RLN transection, only five underwent primary repair or ansa cervicalis to RLN anastomosis. The only factor associated with amputation of the RLN was a larger tumour size (40.4 vs. 24.7 mm, p = 0.007). Preservation of voice quality was higher in the shave group in comparison to the amputation group (93.5% vs. 71.0%, p = 0.0426).
CONCLUSION: Preservation of nerve or reconstruction in transectional injuries should be considered where possible to improve voice outcomes except in cases when the laryngotracheal complex is involved.