Thyroid cancers with preoperative recurrent nerve palsy:Clinicopathologic features and treatment outcome

【摘要】：Objective To define the significance of recurrent laryngeal nerve palsy (RLNP) detected before surgery for the thyroid cancers with regard to the incidence of malignancy, histopathologic distribution, extrathyroidal invasion, management, and prognosis. Methods Twenty-one patients suffered from a thyroid cancer with preoperative RLNP were reviewed retrospectively between Jan. 2005 and Jun. 2010, with regard to patient demographics, clinical presentations, preoperative computerized tomography (CT) findings, surgical details, pathologic findings, and follow-up records. Results Of the 21 patients, 16 were papillary thyroid cancer (PTC), 3 were anaplastic thyroid cancer (ATC), and the other 2, medullary thyroid cancer. The recurrent laryngeal nerves were invaded by neoplasm in 17 (15 unilateral, 2 bilateral) patients and therefore were sacrificed. The RLNs could be dissected in 1 patient and was found no invasion in another one patient, both patients regained this never's function in 2 days and 1 month postoperatively, respectively. Surgery were not performed in two of the 3 patients withanaplastic thyroid cancer, who were pathologic confirmed by biopsy and fine needle aspiration (FNA) preoperatively. Conclusions Thyroid tumor associated with RLNP is strongly suggestive of malignancy. The RLN should be preserved if it has not been invaded by the tumor, because it offers a good chance of functional recovery postoperatively. Well-differentiated thyroid cancer tend to present at an older age and feature a much higher incidence of upper aerodigestive tract invasion. Special attention should be paid to the patients with bilateral preoperative RLNP, because tracheadectomy is often inevitable. The operations for these patients often are complex and should be performed by experienced surgeons. Radical excision of a resectable anaplastic or medullay thyroid cancer offers the chance of long-term survival.