Summary
Aims
Intraoperative injury to the recurrent laryngeal nerve (RLN) is a serious complication
occurring more frequently in patients with thyroid cancer than in those with benign
thyroid diseases. However, data on the risk factors for RLN injury among patients
with thyroid cancer are scarce. Currently, RLN injury is diagnosed by laryngoscopy,
but translaryngealultrasonography (TLUS), which is less invasive, appears to have
a similar accuracy. Herein, we analysed risk factors ofintraoperative RLN injury in
patients with thyroid cancer and assessed the diagnostic performance of TLUS.
Patients and methods
In this prospective study, we enrolled patients undergoing surgery for thyroid cancer
from October 2020 to October 2021. Medical and surgical variables were analysed as
risk factors of RLN injury. TLUS was compared with laryngoscopy in diagnosing RLN
injury.
Results
There were 185 patients who underwent 196 surgeries. Of all surgeries, 23 (11.7%)
caused RLN injury ascertained on laryngoscopy. Compared with laryngoscopy, TLUS displayed
high sensitivity (97.7%; 95%CI: 94.3%–99.4%) and specificity (100%; 95% CI: 82.4%-100%).
Before surgery, medical and surgical characteristics did not differ significantly
between patients with or without RLN injury, but RLN entrapment by tumour was more
frequent in those with the injury (P < 0.001). The risk of RLN injury was increased in patients undergoing thyroidectomy
with lateral neck dissection (OR = 4.53; 95% CI: 1.29–14.32) and in those with lymph
node metastases (OR = 2.76; 95% CI: 1.03–7.01).
Conclusion
Intraoperative RLN injury in patients with thyroid cancer is more common after operations
requiring greater resections and with lymph node involvement. TLUS could be used to
diagnose RLN injury.
Keywords
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REFERENCES
- Epidemiology of thyroid cancer: a review of the national cancer database, 2000-2013.Cureus. 2019; https://doi.org/10.7759/cureus.4127
- Incidence, risk factors, and natural outcome of vocal fold paresis in 920 thyroid operations with routine pre- and postoperative laryngoscopic evaluation.World J Surg. 2019; 43: 2228-2234https://doi.org/10.1007/s00268-019-05021-y
- Recurrent laryngeal nerve injury after thyroid surgery: an analysis of 11,370 patients.J Surg Res. 2020; 255: 42-49https://doi.org/10.1016/j.jss.2020.05.017
- Surgical management of the recurrent laryngeal nerve in thyroidectomy: American Head and Neck Society Consensus Statement.Head Neck. 2018; 40: 663-675https://doi.org/10.1002/hed.24928
- Management of unilateral recurrent laryngeal nerve injury after thyroid surgery: a review.Head Neck. 2017; 39: 1470-1478https://doi.org/10.1002/hed.24772
- Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: a systematic review.Int J Clin Pract. 2009; 63: 624-629https://doi.org/10.1111/j.1742-1241.2008.01875.x
- Surgeon-performed ultrasound analysis of the status of the vocal cords of post-thyroidectomy patients with intraoperative neuromonitoring in a tertiary referral center.Int J Mol Immuno Oncol. 2020; 5: 121https://doi.org/10.25259/IJMIO_10_2020
- Results of early versus intermediate or delayed voice therapy in patients with unilateral vocal fold paralysis: our experience in 171 patients.J Voice. 2015; 29: 455-458https://doi.org/10.1016/j.jvoice.2014.09.027
- Diagnosis of recurrent laryngeal nerve palsy after thyroidectomy: a systematic review.Int J Clin Pract. 2009; 63: 624-629https://doi.org/10.1111/j.1742-1241.2008.01875.x
- Recurrent laryngeal nerve injury after thyroid surgery: an analysis of 11,370 patients.J Surg Res. 2020; 255: 42-49https://doi.org/10.1016/j.jss.2020.05.017
- Advantages of recurrent laryngeal nerve identification in thyroidectomy and parathyroidectomy and the importance of preoperative and postoperative laryngoscopic examination in more than 1000 nerves at risk.Laryngoscope. 2002; 112: 124-133https://doi.org/10.1097/00005537-200201000-00022
- The effect of lateral neck dissection on complication rate for total thyroidectomy.Am J Otolaryngol. 2020; 41102421https://doi.org/10.1016/j.amjoto.2020.102421
- Risk factors predisposing for recurrent laryngeal nerve palsy following thyroid malignancy surgery: experience from a tertiary oncology centre.Eur Arch Oto-Rhino-Laryngology. 2020; 277: 1199-1204https://doi.org/10.1007/s00405-020-05788-0
- Re-operative thyroid surgery: a 20-year prospective cohort study at a tertiary referral centre.Eur Arch Oto-Rhino-Laryngolog y. 2015; 272: 1503-1508https://doi.org/10.1007/s00405-014-3068-5
- Recurrent laryngeal nerve injury in thyroid surgery: a review.ANZ J Surg. 2013; 83: 15-21https://doi.org/10.1111/j.1445-2197.2012.06247.x
- Prevention and treatment of recurrent laryngeal nerve injury in thyroid surgery.Int J Clin Exp Med. 2014; 7: 101-107
- Complication Risk in Secondary Thyroid Surgery.SiSli Etfal Hastan Tip Bul /Med Bull Sisli Hosp. 2018; https://doi.org/10.14744/SEMB.2017.87609
- Clinical value of intraoperative neuromonitoring of the recurrent laryngeal nerves in improving outcomes of surgery for well-differentiated thyroid cancer.Polish J Surg. 2011; 83https://doi.org/10.2478/v10035-011-0030-8
- Thyroid reoperation using intraoperative neuromonitoring.Endocrine. 2017; 58: 458-466https://doi.org/10.1007/s12020-017-1443-x
- Investigation of recurrent laryngeal palsy rates for potential associations during thyroidectomy.ANZ J Surg. 2020; 90: 1733-1737https://doi.org/10.1111/ans.16166
- Risk factors for permanent laryngeal nerve paralysis in patients with thyroid carcinoma.Clin Otolaryngol. 2007; 32: 378-383https://doi.org/10.1111/j.1749-4486.2007.01536.x
- Recurrent laryngeal nerve injury in thyroid surgery.Oman Med J. 2011; 26: 34-38https://doi.org/10.5001/omj.2011.09
- Thyroid surgery in the geriatric patient.Arch Surg. 2002; 137: 1243https://doi.org/10.1001/archsurg.137.11.1243
- Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery.Surgery. 2004; 136: 1310-1322https://doi.org/10.1016/j.surg.2004.07.018
- Lessons Learned After 1000 Cases of Transcutaneous Laryngeal Ultrasound (TLUSG) with Laryngoscopic Validation: Is There a Role of TLUSG in Patients Indicated for Laryngoscopic Examination Before Thyroidectomy?.Thyroid. 2017; 27: 88-94https://doi.org/10.1089/thy.2016.0407
- Real-time, high-resolution ultrasonography of the vocal folds—a prospective pilot study in patients before and after thyroidectomy.Langenbeck's Arch Surg. 2010; 395: 859-864https://doi.org/10.1007/s00423-010-0694-2
- A prospective study evaluating the feasibility and accuracy of very early postoperative translaryngeal ultrasonography in the assessment of vocal cord function after neck surgery.Surgery. 2021; 169: 191-196https://doi.org/10.1016/j.surg.2020.03.025
- Application of Translaryngeal Ultrasound (TLUS) in Patients with Neck Surgery—A Single-Centre, Prospective Cohort Study on Technique Evaluation.J Clin Med. 2022; 11: 1691https://doi.org/10.3390/jcm11061691
- Laryngeal evaluation during the COVID-19 pandemic: transcervical laryngeal ultrasonography.Otolaryngol Neck Surg. 2020; 163: 51-53https://doi.org/10.1177/0194599820922984
- Transcutaneous laryngeal ultrasonography: a promising tool for otolaryngologists during COVID-19.Am J Otolaryngol. 2021; 42102772https://doi.org/10.1016/j.amjoto.2020.102772
- Severity of recurrent laryngeal nerve injuries in thyroid surgery.World J Surg. 2016; 40: 1373-1381https://doi.org/10.1007/s00268-016-3415-3
Article info
Publication history
Published online: October 08, 2022
Accepted:
August 4,
2022
Publication stage
In Press Corrected ProofFootnotes
Informed consent was obtained from all individual participants included in the study.
The study was approved by the appropriate institution research (National Institute of Oncology) ethics committee.
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Identification
Copyright
© 2022 The Voice Foundation. Published by Elsevier Inc. All rights reserved.
