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

Abstract

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.

Preoperative voice analysis and survival outcomes in papillary thyroid cancer with recurrent laryngeal nerve invasion

“…In this study, only 60 patients experienced preoperative VCP and were identified using laryngoscopy. Other studies have reported that approximately 50–60% of invaded RLNs presented with normal preoperative nerve function ( 12 , 13 ). Alexandre Dahan et al.…”

“…In this study, only 60 patients experienced preoperative VCP and were identified using laryngoscopy. Other studies have reported that approximately 50-60% of invaded RLNs presented with normal preoperative nerve function (12,13). Alexandre Dahan et al reported that even in PTC patients whose RLNs were encased by thyroid tumors, preoperative VCP was present in 16/ 52 cases (30%) (14).…”

Surgical and Biochemical Outcomes in Nerve Monitored Reoperation Surgery for Recurrent Papillary Thyroid Carcinoma

“…Given that around 40% of patients with invaded RLNs report preoperative complaints, vocal and laryngeal examinations are more important than ever in achieving comprehensive care. 9 Patients underwent preoperative and postoperative laryngoscopic examinations in accordance with the American Academy of Otolaryngology-Head Surgery and Neck clinical practice guidelines. 10 We used a 6-month cutoff point to identify permanent VCP and hypocalcemia complications.…”

Aspirin-Loaded Cross-Linked Lipoic Acid Nanodrug Prevents Postoperative Tumor Recurrence by Residual Cancer Cell Killing and Inflammatory Microenvironment Improvement

“…Surgical resection is the mainstay in the clinical treatment of solid tumors. However, because of the infiltrative nature of the malignancy, surgery may not remove the tumor cells completely. − Chemotherapy followed by surgery is the common treatment regimen in clinics for clearance of residual tumor cells. − Unfortunately, ∼33.3% of the postoperative tumor recurrence rate , and 10–40% of the 5 year survival rate − reveal that the clinical benefits are far from meeting expectations. Moreover, since the chemotherapeutic drugs usually suffer from strong side effects, the patients would suffer secondary physical and psychological harm during the treatment.…”