Laryngeal nerve morbidity in 1.273 central node dissections for thyroid cancer. (June 2018)

• Record Type: Journal Article
• Authors: Liu, Xiaoli; Zhang, Daqi; Zhang, Guang; Zhao, Lina; Zhou, Le; Fu, Yantao; Li, Shijie; Zhao, Yishen; Li, Changlin; Wu, Che-Wei; Chiang, Feng-Yu; Dionigi, Gianlorenzo; Sun, Hui
• Is Part Of: Surgical oncology. Volume 27:Number 2(2018)
• Page Start: A21
• Page End: A25
• Publication Date: 2018-06
• Subjects: Central node dissection -- Lymph node metastases -- Morbidity -- Neuromonitoring -- Recurrent laryngeal nerve; Cancer -- Surgery -- Periodicals; Neoplasms -- surgery -- Periodicals; Cancer -- Chirurgie -- Périodiques; Electronic journals; 616.994059
• DOI: 10.1016/j.suronc.2018.01.003
• Languages: English
• ISSNs: 0960-7404

Abstract

Abstract: Aim: We assess the prevalence and mechanism of recurrent laryngeal nerve (RLN) injury in central neck dissection (CND) for thyroid cancer. Methods: CND with intraoperative neural monitoring was outlined in 1.273 nerves at risk (NAR). RLN lesions were stratified according to: timing (during thyroidectomy versus CND), segmental vs. diffuse injury, mechanism, severity, location, number of lymph nodes dissected and metastastatic. EMG parameters were recorded. Results: 49/1.273NAR (3, 8%) documented RLN palsy. 25 nerves were injured during thyroidectomy, 8 while CND. In 16 no precise moment or mechanism of injury was identified. A disrupted point could be identified in 19/25 (76%) and 7/8 (87%) respectively for thyroidectomy and CND steps. Diffuse injury, occurred in 24% and 12, 5% respectively for thyroidectomy and CND. Nerves were injured in the all cervical nerve course without any major location for incidence for CND; for thyroidectomy most nerves were injured in the last 1 cm course. Traction (36%) was the leading cause of RLN injury for thyroidectomy. For solely CND, traction, entrapment and thermal injuries were equally frequent. Permanent vs. transient injuries were respectively 8% (4/49) and 92% (n.45/49), overall. Permanent lesions were equally distributed. Conclusions: During CND, RLN palsy still occurs with routine exposure of the nerve even combined with IONM. The incidence of nerve lesions during thyroidectomy is higher than that of CND. Highlights: Prevalence and mechanism of recurrent laryngeal nerve (RLN) injury during central neck dissection (CND) for cancer in 1.273 nerves at risk. Stratifying by step of operation most lesions occurred while performing thyroidectomy. By mapping the RLN using stimulation, a disrupted point was identified in 76% and 87% respectively for thyroidectomy and CND. Nerves were injured in all cervical RLN course without any major location for CND; for thyroidectomy most nerves were injured in the distal 1 cm. In CND, there was different distribution of causes: traction, entrapment and thermal (25%), ligation (12, 5%).