Routine Intraoperative Neuromonitoring of the Recurrent Laryngeal Nerve to Facilitate Complete Resection and Ensure Safety in Thyroid Cancer Surgery

Routine use of intraoperative neuromonitoring (IONM) in thyroid cancer surgery is controversial. We aimed to investigate whether it improves the completeness of thyroidectomy and ensures safety. This retrospective study included 380 thyroid cancer patients who underwent thyroidectomy, by one surgeon...

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Bibliographic Details
Published in:The American surgeon 2018-12, Vol.84 (12), p.1882-1888
Main Authors: Wu, Si-Yuan, Shen, Hung-Yuan, Duh, Quan-Yang, Hsieh, Chung-Bao, Yu, Jyh-Cherng, Shih, Ming-Lang
Format: Article
Language:English
Subjects:
Ablation
Adult
Cancer
Cancer surgery
Completeness
Diagnostic Tests, Routine
Dissection
Female
Hospitals
Humans
Iodine
Lymphatic system
Male
Medical imaging
Middle Aged
Monitoring, Intraoperative
Nerves
Paralysis
Patients
Recurrent Laryngeal Nerve - physiology
Recurrent Laryngeal Nerve Injuries - diagnosis
Recurrent Laryngeal Nerve Injuries - etiology
Recurrent Laryngeal Nerve Injuries - prevention & control
Retrospective Studies
Safety
Surgeons
Surgery
Technetium
Technetium isotopes
Thoracic surgery
Thyroglobulin
Thyroid
Thyroid cancer
Thyroid Gland - innervation
Thyroid Gland - surgery
Thyroid Neoplasms - surgery
Thyroidectomy
Thyroidectomy - adverse effects
Thyroidectomy - methods
Vocal Cord Paralysis - diagnosis
Vocal Cord Paralysis - etiology
Vocal Cord Paralysis - prevention & control
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Summary:Routine use of intraoperative neuromonitoring (IONM) in thyroid cancer surgery is controversial. We aimed to investigate whether it improves the completeness of thyroidectomy and ensures safety. This retrospective study included 380 thyroid cancer patients who underwent thyroidectomy, by one surgeon, between July 2006 and November 2015. Patients were grouped according to the surgeon's adaptation of IONM, as follows: none (period 1; n = 92), early (period 2; n = 141), and late (period 3; n = 147). The operative time and rates of vocal cord palsy were determined. Surgical completeness was assessed by technetium-99m imaging of the thyroid remnant and serum thyroglobulin measurement before ablation. The rate of recurrent laryngeal nerve (RLN) palsy showed a decreasing trend over time. No permanent RLN palsies occurred in nerves not invaded by tumor after routine IONM was introduced. Technetium-99m uptake (periods 1–3, 0.62 vs 0.32 vs 0.20; P < 0.01) and thyroglobulin levels (periods 1 and 2, 37.93 vs 8.98 ng/mL, respectively; P = 0.034; period 3, 9.10 ng/mL) progressively decreased. The mean thyroglobulin level dropped significantly after introduction of routine IONM. We conclude that routine IONM during thyroid cancer surgery improves surgical completeness and might prevent permanent RLN palsy over time.
ISSN:0003-1348
1555-9823
DOI:10.1177/000313481808401232