Managing the Involved Recurrent Laryngeal Nerve in Thyroid Cancer

Area of Science:

• Otolaryngology
• Surgical Oncology
• Neurosurgery

Background:

• Recurrent laryngeal nerve palsy (RLNP) is a known complication of thyroid surgery.
• This condition can significantly impact a patient's quality of life.

Purpose of the Study:

• To analyze outcomes in patients experiencing RLNP after thyroidectomy for differentiated thyroid malignancy.
• To compare outcomes based on whether the recurrent laryngeal nerve (RLN) was amputated or preserved.

Main Methods:

• Retrospective cohort analysis of 862 patients undergoing thyroidectomy for differentiated thyroid cancer between 2001-2023.
• Patients with RLNP were stratified into groups based on RLN status (amputated vs. preserved).
• Clinicopathological data and patient outcomes were collected and analyzed.

Main Results:

• RLNP occurred in 8.2% of patients (71/862), with most cases being temporary or unilateral.
• The recurrent laryngeal nerve (RLN) was amputated in 50% of cases where transection occurred, often due to tumor infiltration.
• Tumor size was the only factor associated with RLN amputation (p=0.007).
• Voice preservation was significantly higher when the nerve was preserved or shaved compared to amputation (93.5% vs. 71.0%, p=0.0426).

Conclusions:

• Nerve preservation or reconstruction is recommended to improve voice outcomes post-thyroidectomy.
• Exceptions include cases with direct tumor involvement of the laryngotracheal complex.
• Surgical strategy should aim to balance oncologic control with functional preservation of the RLN.