Papillary thyroid carcinoma with exclusive involvement of a functioning recurrent laryngeal nerve may be treated with shaving technique.

Abstract

We sought to validate the feasibility of preserving a functioning recurrent laryngeal nerve (RLN) invaded by papillary thyroid carcinoma (PTC) using a shaving technique followed by high-dose radioactive iodine (RAI) therapy. A retrospective review of 34 patients with locally invasive PTC who had exclusive tumor involvement of a functioning RLN was performed. All patients underwent total thyroidectomy and high-dose RAI therapy. A shaving technique was conducted with the goal of leaving the smallest amount of residual tumor as possible while attempting to preserve nerve function. Clinicopathologic factors and oncologic outcomes of the patients with resected RLN (group A, n = 14) and preserved RLN (group B, n = 20) were compared. The two groups showed no differences in clinicopathologic factors or follow-up period. Mean dose of radioiodine therapy was 245.0 ± 140.3 mCi (range 100-540 mCi). Permanent postoperative vocal cord paralysis after RLN shaving occurred in two patients of group B (10%). Only one patient (5%) in group B had local recurrence at the thyroid bed where the residual tumor was located. The overall recurrence rate was 35.7% (5/14) and 20.0% (4/20) in groups A and B, respectively showing no significant difference (p = 0.525). There were no cases of death due to PTC during the median follow-up of 75 months (range 36-159 months). Patients with locally invasive PTC with exclusive involvement of a functioning RLN may be treated by nerve shaving followed by treatment of the macroscopic residual tumor with high-dose RAI therapy.