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Should an Involved but Functioning Recurrent Laryngeal Nerve be Shaved or Resected in a Locally Advanced Papillary Thyroid Carcinoma?

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

Abstract

Background

The issue of whether an involved but functioning recurrent laryngeal nerve (RLN) should be shaved or resected in locally advanced papillary thyroid carcinoma (PTC) remains controversial. Our study aimed to compare the early and late outcomes between those who underwent shaving and those who underwent resection and also to identify independent prognostic factors in this subset of patients.

Methods

Of the 77 patients with 1 RLN involved by PTC, 39 (50.6 %) underwent RLN preservation (group I) while 38 (49.4 %) underwent RLN resection (group II). Early and late vocal cord function (as assessed by flexible laryngoscopy) and disease status were compared between the 2 groups. A multivariate Cox proportional hazards model was carried out to identify independent factors.

Results

Baseline characteristics were comparable between the 2 groups. Although temporary vocal cord palsy rate was similar between the 2 groups (p = 0.532), 5 patients in group II (13.2 %) suffered temporary bilateral vocal cord palsies with 1 requiring a tracheostomy lasting for 1 month. After a median follow-up of 113.8 months, 1 patient from each group developed new onset vocal cord palsy. Presence of distant metastases (hazard ratio [HR] = 5.892, 95 % CI = 1.971–17.604, p = 0.001) and incomplete surgical resection in non-RLN concomitant sites (HR = 2.491, 95 % CI = 1.181–5.476, p = 0.024) were the 2 independent predictors for a poor cancer-specific survival.

Conclusions

Our data suggested that shaving could preserve the normal functionality in most of the involved RLNs (>90 %) in the short to medium term. In the presence of distant metastases or incomplete resection in other non-RLN concomitant sites, the argument for shaving over resection appears even stronger.

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Authors and Affiliations

  1. Division of Endocrine Surgery, Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong SAR

    Brian Hung-Hin Lang MS, FRACS, Chung-Yau Lo MBBS, FRCS & Kai Pun Wong MBBS, FRCS

  2. Department of Clinical Oncology, Queen Mary Hospital, Pokfulam, Hong Kong SAR

    Koon Yat Wan MBBS, FRCR

Authors
  1. Brian Hung-Hin Lang MS, FRACS
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  2. Chung-Yau Lo MBBS, FRCS
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  3. Kai Pun Wong MBBS, FRCS
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  4. Koon Yat Wan MBBS, FRCR
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Correspondence to Brian Hung-Hin Lang MS, FRACS.

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Lang, B.HH., Lo, CY., Wong, K.P. et al. Should an Involved but Functioning Recurrent Laryngeal Nerve be Shaved or Resected in a Locally Advanced Papillary Thyroid Carcinoma?. Ann Surg Oncol 20, 2951–2957 (2013). https://doi.org/10.1245/s10434-013-2984-8

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  • DOI: https://doi.org/10.1245/s10434-013-2984-8

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