Preservation of the Recurrent Laryngeal Nerve Invaded by Thyroid Cancer

To assess surgical management strategies for recurrent laryngeal nerve (RLN) invasion in patients with locally advanced thyroid cancer, with particular emphasis on the use of intraoperative neuromonitoring (IONM) and its influence on nerve preservation.

An observational study. Place and Duration of the Study: Department of General Surgery, Faculty of Medicine, Akdeniz University, Antalya, Turkiye, from January 2021 to January 2023.

A retrospective analysis was conducted on 24 patients with RLN invasion who underwent thyroid surgery. Surgical decision-making-whether to preserve or resect the RLN-was guided by IONM findings and the extent of tumour invasion. Postoperative vocal cord function was assessed using fibreoptic laryngoscopy at multiple intervals. Qualitative data were presented as frequencies and percentages.

In 17 patients, the RLN was preserved using sharp dissection, with varying degrees of nerve wall involvement. Temporary vocal cord dysfunction was observed in some patients but resolved within six months. In three patients with >50% RLN circumferential invasion, nerve resection without reconstruction was performed. RLN reconstruction using the ansa cervicalis was achieved in two cases. No cases of local recurrence were reported during follow-up.

RLN preservation using IONM-guided shaving techniques can be a safe and effective alternative to nerve resection in selected patients with functional preoperative vocal cords. Partial nerve resection may also be feasible without compromising oncological safety. These findings highlight the importance of individualised surgical planning and suggest the need for standardised protocols in managing RLN invasion.

Thyroid cancer, Recurrent laryngeal nerve, Neuromonitoring.