Papillary Thyroid Carcinoma with Exclusive Involvement of a Functioning Recurrent Laryngeal Nerve May Be Treated with Shaving Technique

Lee, Hyoung Shin; Kim, Sung Won; Park, Taejung; Nam, Gi Yun; Hong, Jong Chul; Lee, Kang Dae

doi:10.1007/s00268-014-2906-3

Cited by 19 publications

(11 citation statements)

References 17 publications

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“…Our results are similar to prior studies of differentiated thyroid carcinomas, which showed no survival benefit difference in patients based on whether an invaded RLN was resected or left intact with a surrounding tumor 1,3,18 . Another study reported no recurrence difference between using shaving technique and RAI for functioning invaded RLN compared with RLN resection 19 …”

Section: Discussionsupporting

confidence: 89%

“…1,3,18 Another study reported no recurrence difference between using shaving technique and RAI for functioning invaded RLN compared with RLN resection. 19 Although RLN invasion denotes a more aggressive disease, our cohort included patients who underwent hemithyroidectomy. This can be explained by referral of patients to undergo completion surgery, the use of staged surgery in selected patients, 12,13 and the use of ipsilateral hemithyroidectomy combined with RAI ablation of a contralateral anodular lobe.…”

Section: Discussionmentioning

confidence: 99%

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Recurrent Laryngeal Nerve Invasion by Thyroid Cancer: Laryngeal Function and Survival Outcomes

et al. 2022

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Background: Recurrent laryngeal nerve (RLN) invasion by thyroid carcinoma represents an advanced disease status with potentially significant co-morbidity.Methods: In a retrospective single-center study, we included patients with invaded RLNs operated on while using nerve monitoring techniques. We studied pre-, intra-, and postoperative parameters associated with postoperative vocal cord paralysis (VCP); 5-year recurrence-free survival (RFS); and 5-year overall survival (OS) in addition to two subgroup analyses of postoperative VCP in patients without preoperative VCP and based on source of RLN invasion.Results: Of 65 patients with 66 nerves-at-risk, 39.3% reported preoperative voice complaints. Preoperative VCP was documented in 43.5%. The RLN was invaded by primary tumor in 59.3% and nodal metastasis in 30.5%. Papillary thyroid carcinoma was the most common pathologic subtype (80%). After 6 months, 81.8% had VCP. Complete tumor resection of the RLN was not associated with 5-year RFS (p = 0.24) or 5-year OS (p = 0.9). Resecting the RLN did not offer statistically significant benefit on 5-year RFS (p = 0.5) or 5-year OS (p = 0.38). Radioactive Iodine (RAI) administration was associated with improvement in 5-year RFS (p = 0.006) and 5-year OS (p = 0.004). Patients without preoperative VCP had higher IONM amplitude compared with patients with VCP. After a mean follow-up of 65.8 months, 35.9% of patients had distant metastases, whereas 36.4% had recurrence.Conclusion: Preoperative VCP accompanies less than half of patients with RLN invasion. Invaded RLNs may have existent electrophysiologic stimulability. Complete tumor resection and RLN resection were not associated with better 5-year RFS or OS, but postoperative RAI was.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Recurrent Laryngeal Nerve Invasion by Thyroid Cancer: Laryngeal Function and Survival Outcomes

et al. 2022

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“…On the other hand, Lee et al 20 reported that none of the investigated factors had a signi cant correlation with recurrence in patients with locally invasive PTC and the exclusive involvement of a functioning RLN.…”

Section: Discussionmentioning

confidence: 96%

Clinical Outcomes of T4a Papillary Thyroid Cancer With Recurrent Laryngeal Nerve Involvement: A Retrospective Analysis

Kwon

Shin

et al. 2020

Preprint

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Preoperative vocal cord palsy (VCP) may indicate locally invasive papillary thyroid cancer (PTC); using this relationship, we evaluated the clinical outcomes and risk factors for recurrence in post-thyroidectomy T4a PTC patients with recurrent laryngeal nerve (RLN) involvement. We retrospectively investigated thyroidectomy patients, recorded their clinical factors, recurrence rate, and pathological findings, and analysed the relationship between recurrence rate and clinical factors. Of 72 patients, 37 (51%) had preoperative VCP and 35 (49%) had normal preoperative vocal cord movement with confirmed intraoperative RLN invasion. Tracheal and esophageal invasion was observed in 13 (18%) and 15 (21%) patients, respectively. Thyroid cancer recurred in 18 (25%) patients over 58 months, resulting in 2 (3%) deaths. Recurrence was not associated with surgical extent, organ invasion, enlarged tumour size, or lymph node infiltration (p > 0.05). The recurrence rate was significantly higher in patients with positive resection margins (p < 0.05). T4a PTC patients with RLN involvement showed a poor prognosis. The recurrence rate was not affected by preoperative VCP, intraoperative detection of RLN invasion, nerve resection, nerve preservation by shaving, lymph node metastasis, or tracheal or esophageal invasion. The most important prognostic factor for recurrence was a positive resection margin.

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“…Four patients (20%) who underwent shaving showed recurrence, but recurrence to the shaving lesion was detected in only one of them (5%). None of the patients died of carcinoma during the post-operative follow-up (average 85 months) [244].…”

Section: Patients Without Symptoms or Findings Of Nerve Paralysis Prementioning

confidence: 97%

The revised clinical practice guidelines on the management of thyroid tumors by the Japan Associations of Endocrine Surgeons: Core questions and recommendations for treatments of thyroid cancer

Onoda²,

2020

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The Japan Associations of Endocrine Surgeons has developed the revised version of the Clinical Practice Guidelines for Thyroid Tumors. This article describes the guidelines translated into English for the 35 clinical questions relevant to the therapeutic management of thyroid cancers. The objective of the guidelines is to improve health-related outcomes in patients with thyroid tumors by enabling users to make their practice evidence-based and by minimizing any variations in clinical practice due to gaps in evidential knowledge among physicians. The guidelines give representative flowcharts on the management of papillary, follicular, medullary, and anaplastic thyroid carcinoma, along with recommendations for clinical questions by presenting evidence on the relevant outcomes including benefits, risks, and health conditions from patients' perspective. Therapeutic actions were recommended or not recommended either strongly (◎◎◎ or XXX) based on good evidence ( )/good expert consensus (+++), or weakly (◎, ◎◎ or X, XX) based on poor evidence ( )/poor expert consensus (+ or ++). Only 10 of the 51 recommendations given in the guidelines were supported by good evidence, whereas 35 were supported by good expert consensus. While implementing the current guidelines would be of help to achieve the objective, we need further clinical research to make our shared decision making to be more evidence-based.

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Papillary Thyroid Carcinoma with Exclusive Involvement of a Functioning Recurrent Laryngeal Nerve May Be Treated with Shaving Technique

Abstract: Patients with locally invasive PTC with exclusive involvement of a functioning RLN may be treated by nerve shaving followed by treatment of the macroscopic residual tumor with high-dose RAI therapy.

Cited by 19 publications

References 17 publications

Recurrent Laryngeal Nerve Invasion by Thyroid Cancer: Laryngeal Function and Survival Outcomes

Recurrent Laryngeal Nerve Invasion by Thyroid Cancer: Laryngeal Function and Survival Outcomes

Clinical Outcomes of T4a Papillary Thyroid Cancer With Recurrent Laryngeal Nerve Involvement: A Retrospective Analysis

The revised clinical practice guidelines on the management of thyroid tumors by the Japan Associations of Endocrine Surgeons: Core questions and recommendations for treatments of thyroid cancer

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