Surgical oncology · 2018
Laryngeal nerve morbidity in 1.273 central node dissections for thyroid cancer.
СтатьяНазвание и аннотация: Перевод в очереди
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Liu Xiaoli, Zhang Daqi, Zhang Guang, Zhao Lina, Zhou Le, Fu Yantao, Li Shijie, Zhao Yishen, Li Changlin, Wu Che-Wei, Chiang Feng-Yu, Dionigi Gianlorenzo, Sun Hui
Аннотация
AIM: We assess the prevalence and mechanism of recurrent laryngeal nerve (RLN) injury in central neck dissection (CND) for thyroid cancer.
METHODS: CND with intraoperative neural monitoring was outlined in 1.273 nerves at risk (NAR). RLN lesions were stratified according to: timing (during thyroidectomy versus CND), segmental vs. diffuse injury, mechanism, severity, location, number of lymph nodes dissected and metastastatic. EMG parameters were recorded.
RESULTS: 49/1.273NAR (3,8%) documented RLN palsy. 25 nerves were injured during thyroidectomy, 8 while CND. In 16 no precise moment or mechanism of injury was identified. A disrupted point could be identified in 19/25 (76%) and 7/8 (87%) respectively for thyroidectomy and CND steps. Diffuse injury, occurred in 24% and 12,5% respectively for thyroidectomy and CND. Nerves were injured in the all cervical nerve course without any major location for incidence for CND; for thyroidectomy most nerves were injured in the last 1 cm course. Traction (36%) was the leading cause of RLN injury for thyroidectomy. For solely CND, traction, entrapment and thermal injuries were equally frequent. Permanent vs. transient injuries were respectively 8% (4/49) and 92% (n.45/49), overall. Permanent lesions were equally distributed.
CONCLUSIONS: During CND, RLN palsy still occurs with routine exposure of the nerve even combined with IONM. The incidence of nerve lesions during thyroidectomy is higher than that of CND.
METHODS: CND with intraoperative neural monitoring was outlined in 1.273 nerves at risk (NAR). RLN lesions were stratified according to: timing (during thyroidectomy versus CND), segmental vs. diffuse injury, mechanism, severity, location, number of lymph nodes dissected and metastastatic. EMG parameters were recorded.
RESULTS: 49/1.273NAR (3,8%) documented RLN palsy. 25 nerves were injured during thyroidectomy, 8 while CND. In 16 no precise moment or mechanism of injury was identified. A disrupted point could be identified in 19/25 (76%) and 7/8 (87%) respectively for thyroidectomy and CND steps. Diffuse injury, occurred in 24% and 12,5% respectively for thyroidectomy and CND. Nerves were injured in the all cervical nerve course without any major location for incidence for CND; for thyroidectomy most nerves were injured in the last 1 cm course. Traction (36%) was the leading cause of RLN injury for thyroidectomy. For solely CND, traction, entrapment and thermal injuries were equally frequent. Permanent vs. transient injuries were respectively 8% (4/49) and 92% (n.45/49), overall. Permanent lesions were equally distributed.
CONCLUSIONS: During CND, RLN palsy still occurs with routine exposure of the nerve even combined with IONM. The incidence of nerve lesions during thyroidectomy is higher than that of CND.