Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
Endocrinol Metab (Seoul). 2020 Dec;35(4):918-924. doi: 10.3803/EnM.2020.778. Epub 2020 Dec 23.
The use of intraoperative neuromonitoring (IONM) in thyroid surgery to preserve recurrent laryngeal nerve (RLN) function has been widely accepted. We aimed to evaluate the usefulness of IONM in reoperation for recurrent thyroid cancer patients to help identify the RLN and prevent vocal cord palsy (VCP).
We analyzed 121 consecutive patients (with IONM group, 48 patients; without IONM group, 73 patients) who underwent reoperation for recurrent thyroid cancer after total thyroidectomy from January 2009 to March 2019 in our institution without VCP due to previous operations. Data including age, sex, number of previous operations, histologic subtype of the malignancy at the initial operation, operation time, RLNs at risk, difficulty of RLN identification, surgical procedure, VCP, and other postoperative complications were reviewed. Vocal cord movement evaluations were performed preoperatively and at 2 weeks postoperatively to evaluate RLN function. In patients with VCP, additional evaluations were performed. VCP exceeding 12 months after surgery was considered permanent VCP.
VCP was observed in six (12.5%) and 16 (21.9%) patients with and without IONM (P=0.189). Transient and permanent VCP were found in three (6.3%) and three (6.3%) patients with IONM (P=0.098 and P=0.982, respectively) versus in 12 (16.4%) and four (5.5%) patients without IONM.
The incidence of transient VCP seems to be lower in reoperations with IONM; however, there was no statistical significances. Further study will be needed to ascertain the efficacy of IONM in reoperation for recurrent thyroid cancer patients.
术中神经监测（IONM）在甲状腺手术中用于保留喉返神经（RLN）功能已被广泛接受。我们旨在评估 IONM 在复发性甲状腺癌患者再次手术中的有用性，以帮助识别 RLN 并预防声带麻痹（VCP）。
我们分析了 2009 年 1 月至 2019 年 3 月期间在我们机构因先前手术而未发生 VCP 的情况下，因复发性甲状腺癌行全甲状腺切除术并再次手术的 121 例连续患者（IONM 组 48 例，无 IONM 组 73 例）。回顾了包括年龄、性别、先前手术次数、初始手术时恶性肿瘤的组织学亚型、手术时间、有风险的 RLN、RLN 识别难度、手术程序、VCP 和其他术后并发症等数据。在术前和术后 2 周评估 RLN 功能，对声带运动进行评估。在发生 VCP 的患者中，进行了额外的评估。术后 12 个月后持续存在的 VCP 被认为是永久性 VCP。
IONM 组和无 IONM 组中分别有 6 例（12.5%）和 16 例（21.9%）患者出现 VCP（P=0.189）。IONM 组中发现 3 例（6.3%）和 3 例（6.3%）患者出现暂时性和永久性 VCP（P=0.098 和 P=0.982），而无 IONM 组中发现 12 例（16.4%）和 4 例（5.5%）患者出现暂时性和永久性 VCP。
IONM 组再次手术中暂时性 VCP 的发生率似乎较低，但无统计学意义。需要进一步研究以确定 IONM 在复发性甲状腺癌患者再次手术中的疗效。
