Predictive factors and risk analysis of recurrent laryngeal nerve invasion in papillary thyroid carcinoma ≤ 1 cm

Abstract

Objective:The recurrent laryngeal nerve (RLN) may be involved by papillary thyroid carcinoma ≤ 1 centimeter (PTC ≤ 1 cm). Current study investigated the predictive factors of RLN invasion in PTC ≤ 1 cm, the risk factors of disease recurrence in RLN invaded cases and the results of surgical management for RLN invasion. Materials and methods: Data of 374 PTC ≤ 1 cm patients were retrospectively collected. We performed univariate and multivariate analysis to identify predictive factors of RLN invasion and risk factors of disease recurrence. The abilities of factors in predicting RLN invasion were evaluated. Surgical outcomes and recurrence free survival (RFS) of patients were analyzed. Results: A total of 28 patients suffered RLN invasion, among which seven had disease recurrence. Preoperative vocal cord palsy (VCP), gross extrathyroidal extension, larger tumor size and tumor on the dorsal side of thyroid were verified as predictive factors of RLN invasion. RLN involved patients had poorer RFS, but better than those who also had upper-aerodigestive tract invasion. Upper-aerodigestive tract invasion, lateral neck lymph nodes metastasis (LNM) and BRAF V600E mutation were independent risk factors of disease recurrence in RLN invaded cases. Tumor shaving showed better RLN function preservation without increasing recurrent risk. Conclusions: Current study confirmed the rarity of RLN invasion in PTC ≤ 1 cm. Various aggressive features were verified as predictive factors of RLN invasion. Tumor shaving showed superiority in preserving nerve function without increasing recurrent risk. Special attentions should be paid for disease recurrence when RLN invasion accompanied by upper-aerodigestive tract invasion, lateral neck LNM or BRAF V600E mutation.

Establishment and verification of the first prognostic nomograms in locally advanced thyroid cancer based on the analysis of clinical and follow-up information on 2396 patients

“…Our study concluded that radical surgical treatment is an important influence on the prognosis of LATC, and long-term clinical practice and the results of a large number of case summaries have also proved that the choice of the first standardized surgical approach determines the final outcome of TC, and is the most important factor determining the prognosis and efficacy of treatment. However, studies have shown that despite initial standardized treatment, recurrence or DM still occurs in about 15 % of TC patients [ 30 ]. LATC can significantly invade the surrounding vital structures and has a poorer prognosis, and its surgical scope is extensive and involves the resection and reconstruction of vital organs, with greater surgical trauma and surgical risk and a higher complication rate, so discussions on the appropriate extent of surgical resection for LATC remain controversial [ 31 ].…”

The Effect of Hemithyroidectomy in Papillary Thyroid Carcinoma with an Exclusive Involvement of the Recurrent Laryngeal Nerve: A Retrospective Study with a Propensity Score-Matched Analysis

“…Falk et al demonstrated that complete excision of PTC with resection of the RLN did not improve survival compared to incomplete excision [ 39 ]. In the study of Yang et al, tumor shaving showed superiority in preserving RLN function without increasing the risk of recurrence in patients with papillary thyroid microcarcinoma [ 40 ]. The RLN invasion was commonly associated with other invaded structures.…”