Endocrinol Metab.  2020 Dec;35(4):918-924. 10.3803/EnM.2020.778.

Efficacy of Intraoperative Neuromonitoring in Reoperation for Recurrent Thyroid Cancer Patients

• Kim Ji
• Kim Sj
• Xu Z
• Kwak J
• Ahn Jh
• Yu HW
• Chai YJ
• Choi JY
• Lee KE

• KMID: 2511019
• DOI: http://doi.org/10.3803/EnM.2020.778

Abstract

Background
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).
Methods
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.
Results
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.
Conclusion
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.

Keyword

Reoperation; Vocal cord paralysis; Recurrent laryngeal nerve; Thyroid neoplasms; Recurrence

Figure

• 

  Fig. 1 Yearly distribution of recurrent thyroid cancer operations with regard to the use of intraoperative neuromonitoring (IONM) among patients treated in 2009 to 2019 (with IONM [n=48], without IONM [n=73]).

Reference

1. Prete A, Borges de Souza P, Censi S, Muzza M, Nucci N, Sponziello M. Update on fundamental mechanisms of thyroid cancer. Front Endocrinol (Lausanne). 2020; 11:102.

2. Hei H, Zhou B, Qin J, Song Y. Intermittent intraoperative nerve monitoring in thyroid reoperations: preliminary results of a randomized, single-surgeon study. Head Neck. 2016; 38(Suppl 1):E1993–7.

3. Randolph GW, Kamani D. Intraoperative neural monitoring in thyroid cancer surgery. Langenbecks Arch Surg. 2014; 399:199–207.

4. Thomusch O, Sekulla C, Walls G, Machens A, Dralle H. Intraoperative neuromonitoring of surgery for benign goiter. Am J Surg. 2002; 183:673–8.

5. Robertson ML, Steward DL, Gluckman JL, Welge J. Continuous laryngeal nerve integrity monitoring during thyroidectomy: does it reduce risk of injury? Otolaryngol Head Neck Surg. 2004; 131:596–600.

6. Yarbrough DE, Thompson GB, Kasperbauer JL, Harper CM, Grant CS. Intraoperative electromyographic monitoring of the recurrent laryngeal nerve in reoperative thyroid and parathyroid surgery. Surgery. 2004; 136:1107–15.

7. Randolph GW, Dralle H, Abdullah H, Barczynski M, Bellantone R, International Intraoperative Monitoring Study Group, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: international standards guideline statement. Laryngoscope. 2011; 121(Suppl 1):S1–16.

8. Dralle H, Sekulla C, Lorenz K, Brauckhoff M, Machens A; German IONM Study Group. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg. 2008; 32:1358–66.

9. Cirocchi R, Arezzo A, D’Andrea V, Abraha I, Popivanov GI, Avenia N, et al. Intraoperative neuromonitoring versus visual nerve identification for prevention of recurrent laryngeal nerve injury in adults undergoing thyroid surgery. Cochrane Database Syst Rev. 2019; 1:CD012483.

10. Mirallie E, Caillard C, Pattou F, Brunaud L, Hamy A, Dahan M, et al. Does intraoperative neuromonitoring of recurrent nerves have an impact on the postoperative palsy rate?: results of a prospective multicenter study. Surgery. 2018; 163:124–9.

11. Schlumberger MJ. Papillary and follicular thyroid carcinoma. N Engl J Med. 1998; 338:297–306.

12. Randolph GW. Surgery of the thyroid and parathyroid glands. 2nd ed. Philadelphia: Saunders/Elsevier;2013. Chapter 36, Surgical anatomy and monitoring of the recurrent laryngeal nerve. p. 326.

13. Barczynski M, Konturek A, Pragacz K, Papier A, Stopa M, Nowak W. Intraoperative nerve monitoring can reduce prevalence of recurrent laryngeal nerve injury in thyroid reoperations: results of a retrospective cohort study. World J Surg. 2014; 38:599–606.

14. Alesina PF, Rolfs T, Hommeltenberg S, Hinrichs J, Meier B, Mohmand W, et al. Intraoperative neuromonitoring does not reduce the incidence of recurrent laryngeal nerve palsy in thyroid reoperations: results of a retrospective comparative analysis. World J Surg. 2012; 36:1348–53.

15. Salari B, Ren Y, Kamani D, Randolph GW. Revision neural monitored surgery for recurrent thyroid cancer: safety and thyroglobulin response. Laryngoscope. 2016; 126:1020–5.

16. Bae DS, Kim SJ. Intraoperative neuromonitoring of the recurrent laryngeal nerve in robotic thyroid surgery. Surg Laparosc Endosc Percutan Tech. 2015; 25:23–6.

17. Woo JW, Suh H, Song RY, Lee JH, Yu HW, Kim SJ, et al. A novel lateral-approach laryngeal ultrasonography for vocal cord evaluation. Surgery. 2016; 159:52–6.

18. Miccoli P, Frustaci G, Fosso A, Miccoli M, Materazzi G. Surgery for recurrent goiter: complication rate and role of the thyroid-stimulating hormone-suppressive therapy after the first operation. Langenbecks Arch Surg. 2015; 400:253–8.

19. Muller PE, Jakoby R, Heinert G, Spelsberg F. Surgery for recurrent goitre: its complications and their risk factors. Eur J Surg. 2001; 167:816–21.