[Invasion of nerves and vessels in locally spread differentiated cancer of the thyroid gland: surgical strategy].

The author considers clinical manifestation, surgical strategy, immediate and long-term results of operative treatment of 177 (38.1%) patients with invasion of nerve trunks and 147 (31.6%) patients with spread of "neglected" carcinomas of the thyroid gland on the vessels of the neck and mediastinum. It was shown that most often locally-spread differentiated carcinomas and their metastases involve recurrent nerves (31.0%) and internal jugular veins (24.1%) in the pathological process. Thorough preparation of the nerves and arterial trunks using optical magnification allowed avoidance in most cases of circular resections of these structures (in 97.6% and 97.7% respectively) without a considerable elevation of the level of recurrence of tumors (in 3 out of 43 patients). Intraoperative electrophysiological monitoring was an objective factor of decision on the operation volume on the recurrent and accessory nerves as their resection and neurorrhaphy. The level of specific (5.6%) and nonspecific (6.7%) postoperative complications in patients with locally spread of CTG was decreased approximately by 50% during the last decade. Only combined operations gave perspectives for survival and recovery for most patients of the group under consideration.