Skip to main content
AAO-HNSF 2023 Annual Meeting & OTO Experience Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Back
Rate ePoster

Endocrine Surgery

(362) Outcomes of Recurrent Laryngeal Nerve Invasion in Differentiated Thyroid Carcinoma

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Co-Author(s)

  • JB

    Jennifer A. Brooks, MD, MPH

    Assistant Professor Otolaryngology Head and Neck Surgery
    Department of Otolaryngology-Head & Neck Surgery, University of Rochester Medical Center
    Pittsford , New York, United States

    • Presenting Author(s)

  • AS

    Adithya Srikanthan, BS

    Research Fellow
    Massachusetts Eye and Ear Infirmary
    Albany, New York, United States

    • Co-Author(s)

  • AA

    Amr H. Abdelhamid Ahmed, MBBCH, MMSc.

    Director of Research
    Massachusetts Eye and Ear Infirmary
    Boston, Massachusetts, United States

  • BW

    Bo Wang, MD, PhD

    Attending
    Department of Thyroid Surgery, Fujian Medical University Union Hospital
    Fuzhou, Fujian, China (People's Republic)

  • Marika D. Russell, MD

    Clinical Fellow
    Massachusetts Eye and Ear Infirmary
    Boston, MA, United States

    • Senior Author(s)

  • Gregory W. Randolph, MD

    Professor
    Massachusetts Eye and Ear Infirmary Harvard
    Boston, MA, United States

Disclosure(s):
Adithya Srikanthan, BS: No relevant relationships to disclose.
Bo Wang, MD, PhD: No relevant relationships to disclose.
Gregory Randolph, MD: No relevant relationships to disclose.


Introduction: Invasion of recurrent laryngeal nerve (RLN) by tumors may predict disease severity, need for adjuvant therapy, locoregional recurrence (LRR), and mortality. We compared the outcomes of patients diagnosed with differentiated thyroid cancer (DTC) who had invaded RLNs versus those without invasion.

Methods: We retrospectively identified patients who underwent surgery for DTC at a tertiary academic center between 1995-2015. We compared the invaded and the non-invaded groups regarding laryngeal, surgical, and pathological characteristics. Additionally, we reported the 5-year and 10-year recurrence-free survival (RFS) and overall survival (OS) for both groups.

Results: We included 341 patients in our analysis (59 with RLN invasion and 282 without). The invaded group demonstrated significantly higher rates of central and lateral neck lymph node (LN) metastases, and a longer surgical follow-up (47.0 vs. 26.1 months, p=0.0004). In the invaded group, 87.8% of patients received adjuvant therapy, versus 56.8% of the non-invaded group. Invaded group had higher rates of radioactive iodine therapy (RAI) (73.7% vs. 56.4%, p=0.0164), external beam radiation (31.6% vs. 2.0%, p< 0.0001), and chemotherapy (19.3% vs. 1.2%, p< 0.0001), as well as multimodal treatment (33.9% vs 2.0%, p< 0.0001). RAI doses were also significantly higher in the RLN invasion group (96 vs 158 mCi, p< 0.0001). The invaded group had a significantly higher recurrence rate (37.9% vs 8.6%, p< 0.0001). The non-invaded group had significantly better 5-year RFS (93.8% vs 70.6%, p< 0.0001), 5-year OS (98.4% vs 89.8%, p=0.0004), 10-year RFS (92.6% vs 64.4%, p< 0.0001), and 10-year OS (95.8% vs 84.7%, p=0.0002) compared to the invaded group.

Conclusions: DTC with RLN invasion confers severe disease with higher rates of LN metastases, greater need for adjuvant therapy, increased locoregional recurrence risk, and lower overall survival. Discussion of these prognostic factors with patients is paramount to optimize management and guide patients in shared decision-making.