Shaving Versus Resection on Recurrent Laryngeal Nerve in Thyroid Cancer Surgeries: A Systematic Review and Meta-Analysis.

BACKGROUND

Management of recurrent laryngeal nerve (RLN) invasion by thyroid cancer remains controversial between shaving the tumor and resecting it. We compared oncological and functional outcomes of the two techniques.

METHODS

Following PRISMA guidelines, three reviewers searched seven databases for studies from 1995 to 2024 comparing shaving and resection of the RLN. Outcomes explored were overall survival, recurrence, preservation of vocal cord function, maximum phonation time, and other treatment-related morbidities if provided.

RESULTS

A total of 13 retrospective cohorts (532 patients) met inclusion criteria. Overall survival and tracheotomy requirements did not differ between groups. Shaving was associated with lower recurrence (p = 0.007), better vocal fold mobility (p < 0.0001), and longer maximum phonation time (p = 0.04).

CONCLUSION

This analysis showed that shaving was associated with better functional outcomes and lower recurrence than resection, without a survival difference. Because shaved patients had less advanced disease, these associations may reflect selection bias; prospective studies are needed.