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Shaving Papillary Thyroid Carcinoma Involving Functioning Recurrent Laryngeal Nerve: Safety of Incomplete Tumor Resection and Nerve Sparing

  • Endocrine Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Whether to sacrifice or spare the recurrent laryngeal nerve (RLN) when papillary thyroid carcinoma (PTC) involves a functioning RLN remains controversial. Oncological outcomes after shaving PTC with gross remnant on the RLN have been rarely reported. The objective of this study was to evaluate the oncological outcomes of patients who underwent shaving of a PTC from the RLN, leaving a gross residual tumor with the intent of vocal function preservation.

Methods

A retrospective, cohort study was conducted in 47 patients who were determined to have PTC invasion of the RLN via intraoperative inspection and underwent tumor shaving with macroscopic remnant (R2 resection) less than 1 cm in length and 4 mm in thickness. Median follow-up period was 93 (range, 60–215) months. The primary endpoint was the recurrence-free survival and the progression-free survival. Secondary endpoints were biochemical outcomes (serum thyroglobulin) and vocal cord function.

Results

Of the 47 patients, five (10.6%) patients showed recurrence (central neck, 3; lateral neck, 2) without death or distant metastasis. The RLN was resected along with the tumor in one (2.1%) patient who presented with progression of the residual tumor. Postoperative temporary vocal cord paralysis occurred in six (12.8%) patients without permanent cases. The final nonstimulated serum thyroglobulin was 0.7 ± 1.8 ng/ml.

Conclusions

Shaving a tumor from a RLN with gross residual disease may be considered an alternative strategy to preserve vocal function when complete tumor resection with nerve preservation is impossible in patients with PTC invading a functioning RLN.

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Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Republic of Korea

    Hyoung Shin Lee MD, PhD, Yeongjoon Kim MD, Seo Bin Kim MD, Dong Gyu Choi MD & Kang Dae Lee MD, PhD

  2. Department of Medicine, Kosin University College of Medicine, Busan, Republic of Korea

    Hyun Kyoung Cha MD & Ji Su Park

  3. Department of Nuclear Medicine, Kosin University College of Medicine, Busan, Republic of Korea

    Sungmin Jun MD, PhD

Authors
  1. Hyoung Shin Lee MD, PhD
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  2. Yeongjoon Kim MD
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Correspondence to Kang Dae Lee MD, PhD.

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Hyoung Shin Lee, Yeongjoon Kim, Seo Bin Kim, Dong Gyu Choi , Hyun Kyoung Cha, Ji Su Park, Sungmin Jun , Kang Dae Lee have no conflicts of interest to declare. This work did not receive any specific grants from funding agencies in the public, commercial, or not for profit sectors.

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Lee, H.S., Kim, Y., Kim, S.B. et al. Shaving Papillary Thyroid Carcinoma Involving Functioning Recurrent Laryngeal Nerve: Safety of Incomplete Tumor Resection and Nerve Sparing. Ann Surg Oncol 30, 7157–7164 (2023). https://doi.org/10.1245/s10434-023-14142-7

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  • DOI: https://doi.org/10.1245/s10434-023-14142-7

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