The Role of IONM in Reducing the Occurrence of Shoulder Syndrome Following Lateral Neck Dissection for Thyroid Cancer

Journal of Clinical Medicine

Nunzio Velotti¹  Monia Ranalli²  Jacopo Vannucci³  Giovanni Conzo⁴  Fabio Rondelli⁵  Andrea Polistena⁵  Sergio Galasse⁵  Nicola Avenia⁵  Roberta Lucchini⁵  Alessandro Sanguinetti⁵  Renato Patrone⁶  Stefano Avenia⁷ 

[1] Department of Advanced Biomedical Science, University of Naples Federico II, 80131 Naples, Italy;Department of Statistical Sciences, Sapienza University of Rome, 00185 Rome, Italy;Department of Surgery Paride Stefanini, Thoracic Surgery, Sapienza University of Rome, University Hospital Policlinico Umberto I, 00161 Rome, Italy;Department of Traslational Medical Sciences, Division of General and Oncologic Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy;Endocrine Surgery, Santa Maria University Hospital, Perugia University, 05100 Terni, Italy;PhD ICHT, University of Naples Federico II, 80131 Napoli, Italy;Residency Programme in General Surgery, Faculty of Medicine and Surgery, University of Perugia, 06123 Perugia, Italy;

关键词: IONM;    accessory nerve;    shoulder syndrome;    thyroid cancer;    neck dissection;   

DOI  :  10.3390/jcm10184246

来源: DOAJ

【 摘 要 】

Lateral neck dissection (LND) leads to a significant morbidity involving accessory nerve injury. Modified radical neck dissection (MRND) aims at preservation of the accessory nerve, but patients often present with negative functional outcomes after surgery. The role of neuromonitoring (IONM) in the prevention of shoulder syndrome has not yet been defined in comparison to nerve visualization only. We retrospectively analyzed 56 thyroid cancer patients who underwent MRND over a period of six years (2015–2020) in a high-volume institution. Demographic variables, type of surgical procedure, removed lymph nodes and the metastatic node ratio, pathology, adoption of IONM and shoulder functional outcome were investigated. The mean number of lymph nodes removed was 15.61, with a metastatic node ratio of 0.2745. IONM was used in 41.07% of patients, with a prevalence of 68% in the period 2017–2020. IONM adoption showed an effect on post-operative shoulder function. There were no effects in 89.29% of cases, and temporary and permanent effects in 8.93% and 1.79%, respectively. Confidence intervals and two-sample tests for equality of proportions were used when applicable. Expertise in high-volume centres and IONM during MRND seem to be correlated with a reduced prevalence of accessory nerve lesions and limited functional impairments. These results need to be confirmed by larger prospective randomized controlled trials.

【 授权许可】

Unknown