title: Should an involved but functioning recurrent laryngeal nerve be shaved or resected in a locally advanced papillary thyroid carcinoma?
abstract: BACKGROUND
  The issue of whether an involved but functioning recurrent laryngeal nerve (RLN) should be shaved or resected in locally advanced papillary thyroid carcinoma (PTC) remains controversial. Our study aimed to compare the early and late outcomes between those who underwent shaving and those who underwent resection and also to identify independent prognostic factors in this subset of patients.
  
  
  METHODS
  Of the 77 patients with 1 RLN involved by PTC, 39 (50.6%) underwent RLN preservation (group I) while 38 (49.4%) underwent RLN resection (group II). Early and late vocal cord function (as assessed by flexible laryngoscopy) and disease status were compared between the 2 groups. A multivariate Cox proportional hazards model was carried out to identify independent factors.
  
  
  RESULTS
  Baseline characteristics were comparable between the 2 groups. Although temporary vocal cord palsy rate was similar between the 2 groups (p=0.532), 5 patients in group II (13.2%) suffered temporary bilateral vocal cord palsies with 1 requiring a tracheostomy lasting for 1 month. After a median follow-up of 113.8 months, 1 patient from each group developed new onset vocal cord palsy. Presence of distant metastases (hazard ratio [HR]=5.892, 95% CI=1.971-17.604, p=0.001) and incomplete surgical resection in non-RLN concomitant sites (HR=2.491, 95% CI=1.181-5.476, p=0.024) were the 2 independent predictors for a poor cancer-specific survival.
  
  
  CONCLUSIONS
  Our data suggested that shaving could preserve the normal functionality in most of the involved RLNs (>90%) in the short to medium term. In the presence of distant metastases or incomplete resection in other non-RLN concomitant sites, the argument for shaving over resection appears even stronger.
authors: Division of Endocrine Surgery, Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong SAR. blang@hku.hk
authors: Brian Hung-Hin
authors: BH
authors: Lang
authors: Chung-Yau
authors: CY
authors: Lo
authors: Kai Pun
authors: KP
authors: Wong
authors: Koon Yat
authors: KY
authors: Wan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007828:Laryngoscopy; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D012009:Recurrent Laryngeal Nerve / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy / Q000401:mortality; D014826:Vocal Cord Paralysis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D055815:Young Adult