A Prospective Evaluation of Recurrent Laryngeal Nerve Paralysis During Thyroidectomy

Lo, Chung‐Yau; Kwok, Ka–Fai; Yuen, Po Wing

doi:10.1001/archsurg.135.2.204

Cited by 311 publications

(249 citation statements)

References 18 publications

(44 reference statements)

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“…These findings are supported in several other smaller studies, with reported rates for RLNP in thyroid cancer operations ranging from 2% to 50%. 1,6,7,13,21 Our data confirm increased incidence of temporary and permanent RLNP in cancer versus benign disease surgery. The incidence of permanent and transient RLNP in thyroid cancer surgery was 0.28% and 1.82%, respectively.…”

Section: Cancer Surgerysupporting

confidence: 71%

“…This study reports a 4% incidence of RLNP for re-operative thyroid surgery compared with less than 1% for primary procedures. 7 The higher risk of RLNP is generally accepted in the context of disease. 19,20 Our unit's experience is in keeping with the literature.…”

Section: Risk Factors For Rlnp In Thyroid Surgerymentioning

confidence: 99%

“…The Dionigi et al study reported no dominance of RLNP side 32 and is supported by other studies. 7,22 There have been some reports implying the right nerve being injured more regularly. 33 Overall data confirm no difference in the laterality of nerve injured.…”

Section: Left Versus Right Sidementioning

confidence: 99%

“…Over the years, surgical strategy has advanced from non-visualization and avoidance of the RLN to the modern surgical technique of capsular dissection and direct visualization of the RLN. 5 Permanent post-operative RLNP occurs in approximately 0.3-3% of cases 2,[6][7][8][9] and transient palsies in 3-8% of cases. 1,2,7,9,10 Rates of RLNP are most accurately described in terms of 'nerves at risk' (NAR) and are dependent on the type of surgery and nature of disease.…”

Section: Introductionmentioning

confidence: 99%

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Recurrent laryngeal nerve injury in thyroid surgery: a review

Hayward

Grodski

Yeung

et al. 2012

ANZ Journal of Surgery

205

129

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Recurrent laryngeal nerve palsy (RLNP) is an important and potentially catastrophic complication of thyroid surgery. Permanent RLNP occurs in 0.3-3% of cases, with transient palsies in 5-8%. A literature review and analysis of recent data regarding RLNP in thyroid surgery was performed, with particular focus on the identification of high-risk patients, the role of intraoperative identification and dissection of the nerve, and the role of intraoperative neuromonitoring (IONM) and optimal perioperative nerve assessment. In conjunction with the review, data from the Monash University/ Alfred Hospital Endocrine Surgery Unit between January 2007 and October 2011 were retrospectively analysed, including 3736 consecutive nerves at risk (NAR). The current literature and our data confirm that patients undergoing re-operative thyroid surgery and thyroid surgery for malignancies are at increased risk of RLNP. Intraoperative visualization and capsular dissection of the RLN remain the gold standard for intraoperative care during thyroid surgery for reducing RLNP risk. IONM should not be used as the sole mechanism for identifying and preserving the nerve, although it can be used to aid in the identification and dissection of the nerve, and may aid in nerve protection in high-risk cases including cancer surgery and re-operative surgery.

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Section: Cancer Surgerysupporting

confidence: 71%

Section: Risk Factors For Rlnp In Thyroid Surgerymentioning

confidence: 99%

Section: Left Versus Right Sidementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Recurrent laryngeal nerve injury in thyroid surgery: a review

Hayward

Grodski

Yeung

et al. 2012

ANZ Journal of Surgery

205

129

View full text Add to dashboard Cite

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“…Preoperative mammography, ultrasonography, or MRI may be used by the surgeon to guide adequate resection (4)(5)(6). Despite numerous improvements in imaging and surgical technique, the need for reexcision to achieve complete tumor resection in the United States typically ranges from 20-40% (7)(8)(9)(10)(11)(12)(13)(14)(15), and has been reported as being as high as 60% (16). The importance of reexcision is underscored by numerous studies, which have shown that incomplete resection of tumor and positive margins are associated with increased locoregional recurrence compared with negative margins (12,(17)(18)(19)(20).…”

mentioning

confidence: 99%

Application of desorption electrospray ionization mass spectrometry imaging in breast cancer margin analysis

Calligaris

Caragacianu

Liu

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

213

202

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Distinguishing tumor from normal glandular breast tissue is an important step in breast-conserving surgery. Because this distinction can be challenging in the operative setting, up to 40% of patients require an additional operation when traditional approaches are used.Here, we present a proof-of-concept study to determine the feasibility of using desorption electrospray ionization mass spectrometry imaging (DESI-MSI) for identifying and differentiating tumor from normal breast tissue. We show that tumor margins can be identified using the spatial distributions and varying intensities of different lipids. Several fatty acids, including oleic acid, were more abundant in the cancerous tissue than in normal tissues. The cancer margins delineated by the molecular images from DESI-MSI were consistent with those margins obtained from histological staining. Our findings prove the feasibility of classifying cancerous and normal breast tissues using ambient ionization MSI. The results suggest that an MSbased method could be developed for the rapid intraoperative detection of residual cancer tissue during breast-conserving surgery.B reast cancer is the most commonly diagnosed carcinoma in women in the United States and Western countries. Breast conservation surgery (BCS) has become the preferred treatment option for many women with early-stage breast cancer (1). BCS entails resection of the tumor, with a clean margin of normal tissue around it. Surgery is usually followed by radiation therapy. Results from seven large randomized prospective studies, with the largest two having over 20 y of follow-up, have shown equal survival when comparing BCS coupled with whole-breast radiation and mastectomy (2, 3).Normally, breast surgeons aim to remove a patient's tumor, along with a rim of normal tissue that is free of cancer. Preoperative mammography, ultrasonography, or MRI may be used by the surgeon to guide adequate resection (4-6). Despite numerous improvements in imaging and surgical technique, the need for reexcision to achieve complete tumor resection in the United States typically ranges from 20-40% (7-15), and has been reported as being as high as 60% (16). The importance of reexcision is underscored by numerous studies, which have shown that incomplete resection of tumor and positive margins are associated with increased locoregional recurrence compared with negative margins (12,(17)(18)(19)(20). Furthermore, the landmark meta-analysis performed by the Early Breast Cancer Trialists' Collaborative Group (18, 21) directly linked local recurrence to survival, placing great emphasis on the surgeon's role in minimizing local recurrence by obtaining adequate margins.Breast tumor reexcisions are accompanied by a number of undesirable problems: The completion of therapy is delayed, infection rates are increased, cost is increased, there can be a negative psychological impact on the patient, and there can be diminished aesthetic outcomes (22-24). The development of an intraoperative technique that allows the fast and accurate ident...

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