Intraoperative neuromonitoring in thyroid surgery: Is the two-staged thyroidectomy justified?

INTERNATIONAL JOURNAL OF SURGERY

卷:41

Article

Calo, Pietro Giorgio¹  Medas, Fabio¹  Conzo, Giovanni²  Podda, Francesco¹  Canu, Gian Luigi¹  Gambardella, Claudio²  Pisano, Giuseppe¹  Erdas, Enrico¹  Nicolosi, Angelo¹ 

[1] Univ Cagliari, Dept Surg Sci, Cittadella Univ SS554, I-09042 Monserrato, CA, Italy

[2] Univ Campania Luigi Vanvitelli, Sch Med, Div Gen Surg & Surg Oncol, Via Gen G Orsini 42, I-80132 Naples, Italy

关键词: Recurrent laryngeal nerve;    Thyroid surgery;    Intraoperative neuromonitoring;    Thyroidectomy;    Neuromonitoring;    Recurrent laryngeal nerve monitoring;   

DOI  :  10.1016/j.ijsu.2017.02.001

来源: Elsevier

【 摘 要 】

Background: The aim of this study was to evaluate the diagnostic accuracy of intraoperative neuro-monitoring (IONM) in predicting postoperative nerve function during thyroid surgery and its consequent ability to assist the surgeon in intraoperative decision making. Materials and methods: A total of 2365 consecutive patients were submitted to thyroidectomy by the same surgical team. Group A included 1356 patients (2712 nerves at risk) in whom IONM was utilized, and Group B included 1009 patients (2018 nerves at risk) in whom IONM was not utilized. Results: In Group A, loss of signal (LOS) was observed in 37 patients; there were 29 true positive, 1317 true negative, 8 false positive, and 2 false negative cases. Accuracy was 99.3%, positive predictive value was 78.4%, negative predictive value was 99.8%, sensitivity was 93.6%, and specificity was 99.4%. A total of 29 (2.1%) cases of unilateral paralysis were observed, 23 (1.7%) of which were transient and 6 (0.4%) of which were permanent. Bilateral palsy was observed in two (0.1%) cases requiring a tracheostomy. In Group A, 31 (2.3%) injuries were observed, 25 (1.8%) of which were transient and 6 (0.4%) of which were permanent. In Group B, 26 (2.6%) unilateral paralysis cases were observed, 20 (2%) of which were transient and 6 (0.6%) of which were permanent; bilateral palsy was observed in 2 (0.2%) cases. In Group B, 28 (2.8%) injuries were observed, 21 (2.1%) of which were transient and 7 (0.7%) of which were permanent. Differences between the two groups were not statistically significant. Conclusions: Our results show that IONM has a very high sensitivity and negative predictive value, but also good specificity and positive predictive value. For these reasons, in selected patients with LOS, the surgical strategy should be reconsidered. However, patients need to be informed preoperatively about potential strategy changes during the planned bilateral surgery. Future larger and multicenter studies are needed to confirm the benefits of this therapeutic strategy. (C) 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

【 授权许可】

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