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

Lang, Brian Hung‐Hin; Lo, Chung‐Yau; Wong, Kai Pun; Wan, Koon Yat

doi:10.1245/s10434-013-2984-8

Cited by 43 publications

(40 citation statements)

References 15 publications

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“…Some articles showed no prognostic difference if the affected nerve was either completely resected or when the nerve itself was preserved and the tumor tissue was macroscopically radically removed [13, 17, 18]. However, these studies were retrospective, with a small number of patients and a short follow-up or with nonhomogeneous distribution of extrathyroidal involvement in the compared groups.…”

Section: Prognostic Significance Of the Rln Involvementmentioning

confidence: 99%

“…Lang et al retrospectively compared results of 39 and 38 patients, respectively, with the PTC infiltrating the RLN and demonstrated improved short-term and long-term results equally, if the RLN is released from the tumor (by shaving), compared with the radical resection of the infiltrated laryngeal nerve [13]. These two groups were not homogeneous.…”

Section: Prognostic Significance Of the Rln Involvementmentioning

confidence: 99%

“…It is shown that a crucial step of the WDTC therapy is a complete surgical removal of the tumor tissue [11, 12] and macroscopically radical resection is the main parameter determining the survival of the patient [13]. …”

Section: Introductionmentioning

confidence: 99%

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A New Strategy for the Surgical Management of RLN Infiltrated by Well-Differentiated Thyroid Carcinoma

Bouček

Zábrodský

Kuchař

et al. 2014

BioMed Research International

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Well-differentiated thyroid carcinoma (WDTC) represents the most common endocrine malignancy. Despite excellent prognoses exceeding 90% in 10-year follow-up, there are clinically controversial issues. One of these is extrathyroidal tumour extension invading recurrent laryngeal nerve (RLN). The spread outside of the thyroid parenchyma and invasion to the surrounding structures, classified as always T4a, are the most important negative prognostic factor for the WDTC. Conversely, resection of the RLN leads to vocal cord paralysis with hoarseness, possible swallowing problems, and finally decreased quality of life. We propose a new algorithm for intraoperative management based on the MACIS classification, which would allow swift status evaluation pre/intraoperatively and consider a possibility to preserve the infiltrated RLN without compromising an oncological radicality. In the case of a preoperative vocal cord paralysis (VCP) and confirmation of the invasive carcinoma, a resection of the RLN and the nerve graft reconstruction are indicated. Preoperatively, unaffected vocal cord movement and intraoperatively detected RLN infiltration by the invasive WDTC require an individual assessment of the oncological risk by the proposed algorithm. Preservation of the infiltrated RLN is oncologically acceptable only in specific groups of patients of a younger age with a minor size of primary tumour.

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Section: Prognostic Significance Of the Rln Involvementmentioning

confidence: 99%

Section: Prognostic Significance Of the Rln Involvementmentioning

confidence: 99%

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A New Strategy for the Surgical Management of RLN Infiltrated by Well-Differentiated Thyroid Carcinoma

Bouček

Zábrodský

Kuchař

et al. 2014

BioMed Research International

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“…Several studies [6][7][8] have revealed that involvement of RLN had no significant influence on survival, while local invasion to the trachea, larynx, and esophagus [3,5] showed a significant correlation with survival.…”

Section: Introductionmentioning

confidence: 99%

“…The feasibility of preserving an RLN that is functioning but has cancer involvement, followed by the use of adjuvant treatments such as radioactive iodine (RAI) ablation or radiation therapy has been supported by several studies [6][7][8]. However, these studies enrolled patients with relatively inhomogeneous clinical characteristics including patients with preoperative vocal cord paralysis (VCP), concomitant involvement of non-RLN structures, distant metastasis on initial presentation, and involvement of RLN with recurrent metastatic lymph node (LN).…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2014

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Expression of Antioxidant Molecules and Heat Shock Protein 27 in Thyroid Tumors

Wang

Yang

Vlantis

et al. 2016

J of Cellular Biochemistry

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Oxidative stress-induced DNA damage is a known causing factor for many types of tumors, but information on the role of oxidants and antioxidants in thyroid tumors is limited. The aim of this study was to determine antioxidant levels in thyroid tumors. In this study, tumor and its matched non-tumor thyroid tissue samples were obtained from 53 patients with thyroid tumors. The levels of manganese superoxide dismutase (MnSOD), thioredoxin reductase 2 (TXNRD2), glutathione (GSH), glutathione peroxidase (Gpx), catalase (CAT), and 27 kd heat-shock protein (hsp27) were determined in both thyroid tissue samples and cultured thyroid cells by immunohistochemical staining and western blot. Hydrogen peroxide (H2 O2 ) was used to generate oxidant stress in the cell culture experiments. We found that the levels of MnSOD, TXNRD2, GSH, Gpx, and Hsp27 were increased in both malignant and benign tumors, while the level of CAT was decreased. To verify the results of the tissue study, we treated cultured thyroid cells with H2 O2 and found the same pattern of antioxidant changes. Hsp27 was also increased after H2 O2 treatment. The expression of hsp27 was upregulated by 8.24-, 6.96-, and 3.09-fold in thyroid cancer, follicular adenoma, multinodular goiter, respectively. Collectively, our study demonstrated that the levels of hsp27 together with MnSOD, TXNRD2, GSH, and Gpx were significantly upregulated by H2 O2 in thyroid tumors. The increase of these antioxidants is observed in both malignant and benign tumors, particularly in the former. The upregulation of antioxidants is likely a protective mechanism of tumor cells to maintain their survival and growth. J. Cell. Biochem. 117: 2473-2481, 2016. © 2016 Wiley Periodicals, Inc.

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

Cited by 43 publications

References 15 publications

A New Strategy for the Surgical Management of RLN Infiltrated by Well-Differentiated Thyroid Carcinoma

A New Strategy for the Surgical Management of RLN Infiltrated by Well-Differentiated Thyroid Carcinoma

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

Expression of Antioxidant Molecules and Heat Shock Protein 27 in Thyroid Tumors

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