Recurrent laryngeal nerve palsy and substernal goiter. An Italian multicenter study

Area of Science:

• Endocrinology
• Surgical Oncology
• Neurosurgery

Background:

• Recurrent laryngeal nerve palsy is a known complication of total thyroidectomy.
• Substernal goiters present unique surgical challenges.
• Identifying risk factors is crucial for improving surgical safety.

Purpose of the Study:

• To investigate substernal goiter and surgical access as risk factors for recurrent laryngeal nerve palsy (RLNP) after total thyroidectomy.
• To compare RLNP rates between different goiter types and surgical approaches.

Main Methods:

• Retrospective multicenter study of 14,993 patients undergoing total thyroidectomy (1999-2008).
• Patients categorized into: cervical goiters (Group A), substernal goiters (Group B), and substernal goiters requiring manubriotomy (Group C).
• Statistical analysis to compare transient and permanent unilateral/bilateral RLNP rates across groups.

Main Results:

• Groups B and C showed significantly higher rates of transient and permanent unilateral RLNP compared to Group A.
• Transient bilateral palsy was more frequent in B+C vs. A, and C vs. A.
• Permanent bilateral palsy was significantly more frequent in B+C vs. A, and B vs. A.
• Mediastinal extension of goiter correlated with increased RLNP risk.

Conclusions:

• Substernal goiter and specific surgical approaches (manubriotomy) are significant risk factors for RLNP during total thyroidectomy.
• The extent of goiter, particularly mediastinal extension, is associated with a higher incidence of nerve injury.
• These findings underscore the importance of careful surgical planning for substernal goiters.