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Erschienen in: European Archives of Oto-Rhino-Laryngology 4/2020

01.04.2020 | Head and Neck

Risk factors predisposing for recurrent laryngeal nerve palsy following thyroid malignancy surgery: experience from a tertiary oncology centre

verfasst von: Supreet Singh Nayyar, Shivakumar Thiagarajan, Akshat Malik, Adhara Chakraborthy, Parthiban Velayutham, Devendra Chaukar

Erschienen in: European Archives of Oto-Rhino-Laryngology | Ausgabe 4/2020

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Abstract

Background

Postoperative recurrent laryngeal nerve (RLN) palsy is one of the major morbidities encountered after thyroid surgery. The risk further increases when surgery is performed for thyroid malignancies.

Methodology

A retrospective study of patients who underwent hemi, total or completion thyroidectomy at our institute between June 2017 to May 2019 were analyzed. We assessed factors that predisposed to the development of RLN palsy.

Results

The study comprised of 228 patients. A total of 400 nerves were at risk. The RLN palsy rate was 6.8% (n = 27). On univariate and multivariate analysis, the risk of RLN palsy was seen most with pT4a tumor (OR = 8.5), gross extra-thyroidal extension (ETE) (OR = 3.5) and tracheo-esophageal groove (TEG) (OR = 2.8) involvement, followed by aggressive histopathology, and central compartment node positivity.

Conclusion

pT4a tumors, gross ETE, and TEG involvement were the leading causes predisposing for the development of RLN palsy in our series.
Literatur
1.
Zurück zum Zitat Efremidou EI et al (2009) The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases. Can J Surg 52(1):39PubMedPubMedCentral Efremidou EI et al (2009) The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases. Can J Surg 52(1):39PubMedPubMedCentral
2.
Zurück zum Zitat Steurer M et al (2002) Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk. Laryngoscope 112(1):124–133CrossRef Steurer M et al (2002) Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk. Laryngoscope 112(1):124–133CrossRef
3.
Zurück zum Zitat Crumley RL (1994) Unilateral recurrent laryngeal nerve paralysis. J Voice 8(1):79–83CrossRef Crumley RL (1994) Unilateral recurrent laryngeal nerve paralysis. J Voice 8(1):79–83CrossRef
4.
Zurück zum Zitat Altorjay Á et al (2009) Place and value of the recurrent laryngeal nerve (RLN) palpatory method in preventing RLN palsy during thyroid surgery. Head Neck 31(4):538–547CrossRef Altorjay Á et al (2009) Place and value of the recurrent laryngeal nerve (RLN) palpatory method in preventing RLN palsy during thyroid surgery. Head Neck 31(4):538–547CrossRef
5.
Zurück zum Zitat Erbil Y et al (2007) Predictive factors for recurrent laryngeal nerve palsy and hypoparathyroidism after thyroid surgery. Clin Otolaryngol 32(1):32–37CrossRef Erbil Y et al (2007) Predictive factors for recurrent laryngeal nerve palsy and hypoparathyroidism after thyroid surgery. Clin Otolaryngol 32(1):32–37CrossRef
6.
Zurück zum Zitat Jatzko GR et al (1994) Recurrent nerve palsy after thyroid operations—principal nerve identification and a literature review. Surgery 115(2):139–144PubMed Jatzko GR et al (1994) Recurrent nerve palsy after thyroid operations—principal nerve identification and a literature review. Surgery 115(2):139–144PubMed
7.
Zurück zum Zitat Sevim TJ (2007) Risk factors for permanent laryngeal nerve paralysis in patients with thyroid carcinoma. Clin Otolaryngol 32(5):378–383CrossRef Sevim TJ (2007) Risk factors for permanent laryngeal nerve paralysis in patients with thyroid carcinoma. Clin Otolaryngol 32(5):378–383CrossRef
8.
Zurück zum Zitat Atallah I et al (2009) Role of intraoperative neuromonitoring of the recurrent laryngeal nerve in high-risk thyroid surgery. J Otolaryngol Head Neck Surg 38(6):613–618PubMed Atallah I et al (2009) Role of intraoperative neuromonitoring of the recurrent laryngeal nerve in high-risk thyroid surgery. J Otolaryngol Head Neck Surg 38(6):613–618PubMed
9.
Zurück zum Zitat Barczyński M et al (2009) Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg 96(3):240–246CrossRef Barczyński M et al (2009) Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg 96(3):240–246CrossRef
10.
Zurück zum Zitat Pisanu A et al (2014) Systematic review with meta-analysis of studies comparing intraoperative neuromonitoring of recurrent laryngeal nerves versus visualization alone during thyroidectomy. J Surg Res 188(1):152–161CrossRef Pisanu A et al (2014) Systematic review with meta-analysis of studies comparing intraoperative neuromonitoring of recurrent laryngeal nerves versus visualization alone during thyroidectomy. J Surg Res 188(1):152–161CrossRef
11.
Zurück zum Zitat Pantvaidya G et al (2018) Does the recurrent laryngeal nerve recover function after initial dysfunction in patients undergoing thyroidectomy? Laryngoscope Investig Otolaryngol 3(3):249–252CrossRef Pantvaidya G et al (2018) Does the recurrent laryngeal nerve recover function after initial dysfunction in patients undergoing thyroidectomy? Laryngoscope Investig Otolaryngol 3(3):249–252CrossRef
12.
Zurück zum Zitat Tuttle RM, Haugen B, Perrier ND (2017) Updated American Joint Committee on Cancer/tumor-node-metastasis staging system for differentiated and anaplastic thyroid cancer: what changed and why?. Mary Ann Liebert, New York Tuttle RM, Haugen B, Perrier ND (2017) Updated American Joint Committee on Cancer/tumor-node-metastasis staging system for differentiated and anaplastic thyroid cancer: what changed and why?. Mary Ann Liebert, New York
13.
Zurück zum Zitat Čelakovský P et al (2011) Risk factors for recurrent laryngeal nerve palsy after thyroidectomy. Cent Eur J Med 6(3):279–283 Čelakovský P et al (2011) Risk factors for recurrent laryngeal nerve palsy after thyroidectomy. Cent Eur J Med 6(3):279–283
14.
Zurück zum Zitat Zakaria HM et al (2011) Recurrent laryngeal nerve injury in thyroid surgery. Oman Med J 26(1):34CrossRef Zakaria HM et al (2011) Recurrent laryngeal nerve injury in thyroid surgery. Oman Med J 26(1):34CrossRef
15.
Zurück zum Zitat Passler C et al (2002) Thyroid surgery in the geriatric patient. Arch Surg 137(11):1243–1248CrossRef Passler C et al (2002) Thyroid surgery in the geriatric patient. Arch Surg 137(11):1243–1248CrossRef
16.
Zurück zum Zitat Jiang Y et al (2014) Prevention and treatment of recurrent laryngeal nerve injury in thyroid surgery. Int J Clin Exp Med 7(1):101PubMedPubMedCentral Jiang Y et al (2014) Prevention and treatment of recurrent laryngeal nerve injury in thyroid surgery. Int J Clin Exp Med 7(1):101PubMedPubMedCentral
17.
Zurück zum Zitat Chiang F-Y et al (2005) Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve. Surgery 137(3):342–347CrossRef Chiang F-Y et al (2005) Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve. Surgery 137(3):342–347CrossRef
18.
Zurück zum Zitat Ooi LL, Soo KC (1992) Tracheo-oesophageal groove clearance in well-differentiated thyroid carcinoma. Ann Acta Med Singapore 21(5):699–700 Ooi LL, Soo KC (1992) Tracheo-oesophageal groove clearance in well-differentiated thyroid carcinoma. Ann Acta Med Singapore 21(5):699–700
19.
Zurück zum Zitat Roh J-L, Kim J-M, Park CI (2008) Lateral cervical lymph node metastases from papillary thyroid carcinoma: pattern of nodal metastases and optimal strategy for neck dissection. Ann Surg Oncol 15(4):1177–1182CrossRef Roh J-L, Kim J-M, Park CI (2008) Lateral cervical lymph node metastases from papillary thyroid carcinoma: pattern of nodal metastases and optimal strategy for neck dissection. Ann Surg Oncol 15(4):1177–1182CrossRef
20.
Zurück zum Zitat Shaha AR (1998) Management of the neck in thyroid cancer. Otolaryngol Clin N Am 31(5):823–831CrossRef Shaha AR (1998) Management of the neck in thyroid cancer. Otolaryngol Clin N Am 31(5):823–831CrossRef
21.
Zurück zum Zitat Silver CE et al (2011) Aggressive variants of papillary thyroid carcinoma. Head Neck 33(7):1052–1059CrossRef Silver CE et al (2011) Aggressive variants of papillary thyroid carcinoma. Head Neck 33(7):1052–1059CrossRef
22.
Zurück zum Zitat Asioli S et al (2014) Cytomorphologic and molecular features of hobnail variant of papillary thyroid carcinoma: case series and literature review. Diagn Cytopathol 42(1):78–84CrossRef Asioli S et al (2014) Cytomorphologic and molecular features of hobnail variant of papillary thyroid carcinoma: case series and literature review. Diagn Cytopathol 42(1):78–84CrossRef
23.
Zurück zum Zitat Chow S-M et al (2003) Diffuse sclerosing variant of papillary thyroid carcinoma—clinical features and outcome. Eur J Surg Oncol 29(5):446–449CrossRef Chow S-M et al (2003) Diffuse sclerosing variant of papillary thyroid carcinoma—clinical features and outcome. Eur J Surg Oncol 29(5):446–449CrossRef
24.
Zurück zum Zitat Mazzaferri EL, Doherty GM, Steward DL (2009) The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma. Thyroid 19(7):683–689CrossRef Mazzaferri EL, Doherty GM, Steward DL (2009) The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma. Thyroid 19(7):683–689CrossRef
25.
Zurück zum Zitat Pereira JA et al (2005) Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery 138(6):1095–1101CrossRef Pereira JA et al (2005) Nodal yield, morbidity, and recurrence after central neck dissection for papillary thyroid carcinoma. Surgery 138(6):1095–1101CrossRef
26.
Zurück zum Zitat Pantvaidya G et al (2017) Morbidity of central compartment clearance: comparison of lesser versus complete clearance in patients with thyroid cancer. J Cancer Res Ther 13(1):102CrossRef Pantvaidya G et al (2017) Morbidity of central compartment clearance: comparison of lesser versus complete clearance in patients with thyroid cancer. J Cancer Res Ther 13(1):102CrossRef
27.
Zurück zum Zitat Zheng S et al (2013) Effect of intraoperative neuromonitoring on recurrent laryngeal nerve palsy rates after thyroid surgery—a meta-analysis. J Formos Med Assoc 112(8):463–472CrossRef Zheng S et al (2013) Effect of intraoperative neuromonitoring on recurrent laryngeal nerve palsy rates after thyroid surgery—a meta-analysis. J Formos Med Assoc 112(8):463–472CrossRef
28.
Zurück zum Zitat Duclos A et al (2011) Influence of intraoperative neuromonitoring on surgeons’ technique during thyroidectomy. World J Surg 35(4):773–778CrossRef Duclos A et al (2011) Influence of intraoperative neuromonitoring on surgeons’ technique during thyroidectomy. World J Surg 35(4):773–778CrossRef
Metadaten
Titel
Risk factors predisposing for recurrent laryngeal nerve palsy following thyroid malignancy surgery: experience from a tertiary oncology centre
verfasst von
Supreet Singh Nayyar
Shivakumar Thiagarajan
Akshat Malik
Adhara Chakraborthy
Parthiban Velayutham
Devendra Chaukar
Publikationsdatum
01.04.2020
Verlag
Springer Berlin Heidelberg
Erschienen in
European Archives of Oto-Rhino-Laryngology / Ausgabe 4/2020
Print ISSN: 0937-4477
Elektronische ISSN: 1434-4726
DOI
https://doi.org/10.1007/s00405-020-05788-0

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