The Application of Intraoperative Nerve Monitoring in Assessing The Function of The Recurrent Laryngeal Nerve before and after Central Lymph Node Dissection_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LIChang-lin , LIUXiao-li ,  SUNHui

Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University; Jilin Provincial Key Laboratory of Surgical Translational Medicine; Jilin Provincial Engineering Laboratory of Thyroid Disease Prevention and Control, Changchun 130033, China;

Corresponding author：

SUNHui, Email: sunhui1229@163.com

Keywords：

Thyroid cancer; Central lymph node dissection; Intraoperative nerve monitoring; Protection of recurrent laryngeal nerve

DOI：

10.7507/1007-9424.20160305

Video：

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Objective To discuss whether central lymph node dissection (CLND) should be performed for papillary thyroid cancer (PTC) patients. Methods The related domestic and foreign literatures were retrieved, the necessity of CLND and the risk of recurrent laryngeal nerve (RLN) injury in CLND were reviewed, and the application value of intraoperative nerve monitoring (IONM) in CLND were analyzed. Results ① CLND can reduce the recurrence rate of PTC, improve postoperative survival rate, ease the difficulty of reoperation, and help to clarify tumor stage. ② CLND can increase the risk of RLN injury. ③ Application of INOM can decrease the risk of RLN injury. Conclusions The application of IONM during CLND effectively decrease the risk of RLN injury for surgeons, especially low seniority surgeons, and improve the survival quality and the prognosis. This combination will promote the implementation of routine CLND therapeutic strategy in thyroid cancer patients.

Citation： LI Chang-lin, LIU Xiao-li, SUN Hui. The Application of Intraoperative Nerve Monitoring in Assessing The Function of The Recurrent Laryngeal Nerve before and after Central Lymph Node Dissection. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(10): 1188-1192. doi: 10.7507/1007-9424.20160305 Copy

1.	Davies L, Welch HG. Current thyroid cancer trends in the united states. JAMA Otolaryngol Head Neck Surg, 2014, 140(4):317-322.
2.	Siegel R, Ma J, Zou Z, et al. Cancer statistics. CA Cancer J Clin, 2014, 64(1):9-29.
3.	Forest VI, Clark JR, Ebrahimi A, et al. Central compartment dissection in thyroid papillary carcinoma. Ann Surg, 2011, 253(1):123-130.
4.	孙辉, 刘晓莉. 甲状腺手术中喉返神经和喉上神经的保护. 中国实用外科杂志, 2012, 32(5):356-359.
5.	Mazzaferri E, Doherty G, Steward D. The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma. Thyroid, 2009, 19(7):683-689.
6.	Haugen BR, Alexander EK, Bible KC, et al. 2015 american thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer:the american thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid, 2016, 26(1):1-133.
7.	滕卫平, 刘永锋, 高明, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中国肿瘤临床, 2012, 39(17):1249-1272.
8.	Cooper D, Doherty GM, Haugen BR, et al. Revised american thyroid association management guidelines for patients for patients with thyroid nodules and differentiated thyroid cancer:the american thyroid association (ATA) guidelines taskforce on thyroid nodules and differentiated thyroid cancer. Thyroid, 2009, 19(11):1167-1214.
9.	Moo TA, McGill J, Allendorf J, et al. Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma. World J Surg, 2010, 34(6):1187-1191.
10.	Barczyński M, Konturek A, Stopa M, et al. Prophylactic central neck dissection for papillary thyroid cancer. Br J Surg, 2013, 100(3):410-418.
11.	Hartl DM, Mamelle E, Borget I, et al. Influence of prophylactic neck dissection on rate of retreatment for papillary thyroid carcinoma. World J Surg, 2013, 37(8):1951-1958.
12.	Hartl DM, Leboulleux S, Al Ghuzlan A, et al. Optimization of staging of the neck with prophylactic central and lateral neck dissection for papillary thyroid carcinoma. Ann Surg, 2012, 255(4):777-783.
13.	Xiao GZ, Gao L. Central lymph node metastasis:Is it a reliable indicator of lateral node involvement in papillary thyroid carcinoma? World J Surg, 2010, 34(2):237-241.
14.	Sancho JJ, Pascual-Damieta M, Pereira JA, et al. Risk factors for transient vocal cord palsy after thyroidectomy. Br J Surg, 2008, 95(8):961-967.
15.	Sywak M, Cornford L, Roach P, et al. Routine ipsilateral level Ⅵ lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery, 2006, 140(6):1000-1007.
16.	Podnos YD, Smith D, Wagman LD, et al. The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer. Am Surg, 2005, 71(9):731-734.
17.	Wada N, Duh QY, Sugino K, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas:Frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg, 2003, 237(3):399-407.
18.	Lang BH, Wong KP, Wan KY, et al. Impact of routine unilateral central neck dissection on preablative and postablative stimulated thyroglobulin levels after total thyroidectomy in papillary thyroid carcinoma. Ann Surg Oncol, 2012, 19(1):60-67.
19.	Palestini N, Borasi A, Cestino L, et al. Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience. Langenbecks Arch Surg, 2008, 393(5):693-698.
20.	胡治华, 华清泉. 分化型甲状腺癌cN0期Ⅵ区淋巴结清扫必要性的系统评价. 中国医药导报, 2014, 11(9):80-85.
21.	Barczyński M, Konturek A, Stopa M, et al. Nodal recurrence in the lateral neck after total thyroidectomy with prophylactic central neck dissection for papillary thyroid cancer. Langenbecks Arch Surg, 2014, 399(2):237-244.
22.	彭喆, 田文, 姚京, 等. cN0甲状腺乳头状癌行中央区颈淋巴结清扫术的临床研究. 中国普外基础与临床杂志, 2014, 21(5):618-622.
23.	Ji YB, Yoo HS, Song CM, et al. Predictive factors and pattern of central lymph node metastasis in unilateral papillary thyroid carcinoma. Auris Nasus Larynx, 2016, 43(1):79-83.
24.	Giordano D, Valcavi R, Thompson GB, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma:results of a study on 1087 patients and review of the literature. Thyroid, 2012, 22(9):911-917.
25.	Sanabria A, Silver CE, Suárez C, et al. Neuromonitoring of the laryngeal nerves in thyroid surgery:a critical appraisal of the literature. Eur Arch Otorhinolaryngol, 2013, 270(9):2383-2395.
26.	Noguchi S, Yamashita H, Uchino S, et al. Papillary microcarcinoma. World J Surg, 2008, 32(5):747-753.
27.	Hauch A, Al-Qurayshi Z, Randolph G, et al. Total thyroidectomy is associated with increased risk of complications for lowand high-volume surgeons. Ann Surg Oncol, 2014, 21(12):3844-3852.
28.	Lahey FH. Routine dissection and demonstration of the recurrent laryngeal never in subtotal thyroidectomy. Surg Gynecol Obstet, 1938, 66(4):775-777.
29.	Sheed DP, Burget GC. Identification of the recurrent laryngeal nerve. Arch Surg, 1996, 92(6):861-864.
30.	Flisberg K, Lindholm T. Electrical stimulation of the human recurrent laryngeal nerve during thyroid operation. Acta Otolaryngol Suppl, 1970, 263:63-67.
31.	中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺及甲状旁腺手术中神经电生理监测临床指南(中国版). 中国实用外科杂志, 2013, 8(6):470-474.
32.	Randolph GW, Dralle H; International Intraoperative Monitoring Study G, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery:International standards guideline statement. Laryngoscope, 2011, 121 Suppl 1:S1-S16.
33.	Barczyński M, Konturek A, Cichon S. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg, 2009, 96(3):240-246.
34.	Calò PG, Pisano G, Medas F, et al. Identification alone versus intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroid surgery:Experience of 2034 consecutive patients. J Otolaryngol Head Neck Surg, 2014, 43:16.
35.	Barczyński M, Konturek A, Stopa M, et al. Clinical value of intraoperative neuromonitoring of the recurrent laryngeal nerves in improving outcomes of surgery for well-differentiated thyroid cancer. Pol Przegl Chir, 2011, 83(4):196-203.
36.	Neumann HJ. Intraoperative neurophysiological monitoring (IONM) of the recurrent laryngeal nerve and microdissection. Surgical techniques for decreasing the risk of recurrent laryngeal nerve paralysis. Laryngorhinootologie, 2000, 79(5):290-296.
37.	Chuang YC, Huang SM. Protective effect of intraoperative nerve monitoring against recurrent laryngeal nerve injury during re-exploration of the thyroid. World J Surg Oncol, 2013, 11:94.
38.	Hermann M, Hellebart C, Freissmuth M. Neuromonitoring in thyroid surgery:prospective evaluation of intraoperative electrophysiological responses for the prediction of recurrent laryngeal nerve injury. Ann Surg, 2004, 240(1):9-17.

1. Davies L, Welch HG. Current thyroid cancer trends in the united states. JAMA Otolaryngol Head Neck Surg, 2014, 140(4):317-322.
2. Siegel R, Ma J, Zou Z, et al. Cancer statistics. CA Cancer J Clin, 2014, 64(1):9-29.
3. Forest VI, Clark JR, Ebrahimi A, et al. Central compartment dissection in thyroid papillary carcinoma. Ann Surg, 2011, 253(1):123-130.
4. 孙辉, 刘晓莉. 甲状腺手术中喉返神经和喉上神经的保护. 中国实用外科杂志, 2012, 32(5):356-359.
5. Mazzaferri E, Doherty G, Steward D. The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma. Thyroid, 2009, 19(7):683-689.
6. Haugen BR, Alexander EK, Bible KC, et al. 2015 american thyroid association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer:the american thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid, 2016, 26(1):1-133.
7. 滕卫平, 刘永锋, 高明, 等. 甲状腺结节和分化型甲状腺癌诊治指南. 中国肿瘤临床, 2012, 39(17):1249-1272.
8. Cooper D, Doherty GM, Haugen BR, et al. Revised american thyroid association management guidelines for patients for patients with thyroid nodules and differentiated thyroid cancer:the american thyroid association (ATA) guidelines taskforce on thyroid nodules and differentiated thyroid cancer. Thyroid, 2009, 19(11):1167-1214.
9. Moo TA, McGill J, Allendorf J, et al. Impact of prophylactic central neck lymph node dissection on early recurrence in papillary thyroid carcinoma. World J Surg, 2010, 34(6):1187-1191.
10. Barczyński M, Konturek A, Stopa M, et al. Prophylactic central neck dissection for papillary thyroid cancer. Br J Surg, 2013, 100(3):410-418.
11. Hartl DM, Mamelle E, Borget I, et al. Influence of prophylactic neck dissection on rate of retreatment for papillary thyroid carcinoma. World J Surg, 2013, 37(8):1951-1958.
12. Hartl DM, Leboulleux S, Al Ghuzlan A, et al. Optimization of staging of the neck with prophylactic central and lateral neck dissection for papillary thyroid carcinoma. Ann Surg, 2012, 255(4):777-783.
13. Xiao GZ, Gao L. Central lymph node metastasis:Is it a reliable indicator of lateral node involvement in papillary thyroid carcinoma? World J Surg, 2010, 34(2):237-241.
14. Sancho JJ, Pascual-Damieta M, Pereira JA, et al. Risk factors for transient vocal cord palsy after thyroidectomy. Br J Surg, 2008, 95(8):961-967.
15. Sywak M, Cornford L, Roach P, et al. Routine ipsilateral level Ⅵ lymphadenectomy reduces postoperative thyroglobulin levels in papillary thyroid cancer. Surgery, 2006, 140(6):1000-1007.
16. Podnos YD, Smith D, Wagman LD, et al. The implication of lymph node metastasis on survival in patients with well-differentiated thyroid cancer. Am Surg, 2005, 71(9):731-734.
17. Wada N, Duh QY, Sugino K, et al. Lymph node metastasis from 259 papillary thyroid microcarcinomas:Frequency, pattern of occurrence and recurrence, and optimal strategy for neck dissection. Ann Surg, 2003, 237(3):399-407.
18. Lang BH, Wong KP, Wan KY, et al. Impact of routine unilateral central neck dissection on preablative and postablative stimulated thyroglobulin levels after total thyroidectomy in papillary thyroid carcinoma. Ann Surg Oncol, 2012, 19(1):60-67.
19. Palestini N, Borasi A, Cestino L, et al. Is central neck dissection a safe procedure in the treatment of papillary thyroid cancer? Our experience. Langenbecks Arch Surg, 2008, 393(5):693-698.
20. 胡治华, 华清泉. 分化型甲状腺癌cN0期Ⅵ区淋巴结清扫必要性的系统评价. 中国医药导报, 2014, 11(9):80-85.
21. Barczyński M, Konturek A, Stopa M, et al. Nodal recurrence in the lateral neck after total thyroidectomy with prophylactic central neck dissection for papillary thyroid cancer. Langenbecks Arch Surg, 2014, 399(2):237-244.
22. 彭喆, 田文, 姚京, 等. cN0甲状腺乳头状癌行中央区颈淋巴结清扫术的临床研究. 中国普外基础与临床杂志, 2014, 21(5):618-622.
23. Ji YB, Yoo HS, Song CM, et al. Predictive factors and pattern of central lymph node metastasis in unilateral papillary thyroid carcinoma. Auris Nasus Larynx, 2016, 43(1):79-83.
24. Giordano D, Valcavi R, Thompson GB, et al. Complications of central neck dissection in patients with papillary thyroid carcinoma:results of a study on 1087 patients and review of the literature. Thyroid, 2012, 22(9):911-917.
25. Sanabria A, Silver CE, Suárez C, et al. Neuromonitoring of the laryngeal nerves in thyroid surgery:a critical appraisal of the literature. Eur Arch Otorhinolaryngol, 2013, 270(9):2383-2395.
26. Noguchi S, Yamashita H, Uchino S, et al. Papillary microcarcinoma. World J Surg, 2008, 32(5):747-753.
27. Hauch A, Al-Qurayshi Z, Randolph G, et al. Total thyroidectomy is associated with increased risk of complications for lowand high-volume surgeons. Ann Surg Oncol, 2014, 21(12):3844-3852.
28. Lahey FH. Routine dissection and demonstration of the recurrent laryngeal never in subtotal thyroidectomy. Surg Gynecol Obstet, 1938, 66(4):775-777.
29. Sheed DP, Burget GC. Identification of the recurrent laryngeal nerve. Arch Surg, 1996, 92(6):861-864.
30. Flisberg K, Lindholm T. Electrical stimulation of the human recurrent laryngeal nerve during thyroid operation. Acta Otolaryngol Suppl, 1970, 263:63-67.
31. 中国医师协会外科医师分会甲状腺外科医师委员会. 甲状腺及甲状旁腺手术中神经电生理监测临床指南(中国版). 中国实用外科杂志, 2013, 8(6):470-474.
32. Randolph GW, Dralle H; International Intraoperative Monitoring Study G, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery:International standards guideline statement. Laryngoscope, 2011, 121 Suppl 1:S1-S16.
33. Barczyński M, Konturek A, Cichon S. Randomized clinical trial of visualization versus neuromonitoring of recurrent laryngeal nerves during thyroidectomy. Br J Surg, 2009, 96(3):240-246.
34. Calò PG, Pisano G, Medas F, et al. Identification alone versus intraoperative neuromonitoring of the recurrent laryngeal nerve during thyroid surgery:Experience of 2034 consecutive patients. J Otolaryngol Head Neck Surg, 2014, 43:16.
35. Barczyński M, Konturek A, Stopa M, et al. Clinical value of intraoperative neuromonitoring of the recurrent laryngeal nerves in improving outcomes of surgery for well-differentiated thyroid cancer. Pol Przegl Chir, 2011, 83(4):196-203.
36. Neumann HJ. Intraoperative neurophysiological monitoring (IONM) of the recurrent laryngeal nerve and microdissection. Surgical techniques for decreasing the risk of recurrent laryngeal nerve paralysis. Laryngorhinootologie, 2000, 79(5):290-296.
37. Chuang YC, Huang SM. Protective effect of intraoperative nerve monitoring against recurrent laryngeal nerve injury during re-exploration of the thyroid. World J Surg Oncol, 2013, 11:94.
38. Hermann M, Hellebart C, Freissmuth M. Neuromonitoring in thyroid surgery:prospective evaluation of intraoperative electrophysiological responses for the prediction of recurrent laryngeal nerve injury. Ann Surg, 2004, 240(1):9-17.

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The Application of Intraoperative Nerve Monitoring in Assessing The Function of The Recurrent Laryngeal Nerve before and after Central Lymph Node Dissection

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