[En-bloc resection of thyroid carcinoma using recurrent laryngeal nerve tunnel dissection combined with mesothyroid excision: a retrospective analysis of 174 cases].

Abstract

Objectives: To evaluate the application value of recurrent laryngeal nerve tunnel dissection combined with mesothyroid excision in en-bloc resection for thyroid carcinoma.

Methods: A retrospective analysis was conducted on 174 patients with thyroid carcinoma diagnosed by preoperative fine-needle aspiration cytology who underwent surgery at Shaoxing Central Hospital from January 2020 to May 2024. These patients (modified surgery group) received en-bloc resection using recurrent laryngeal nerve tunnel dissection combined with mesothyroid excision, including 143 cases of unilateral radical thyroidectomy, 24 cases of bilateral radical thyroidectomy, and 7 cases of isthmus thyroidectomy. A total of 178 patients diagnosed by preoperative fine-needle aspiration cytology who underwent conventional two-step surgery by the same surgical team during the same period were selected as the conventional surgery group, including 160 cases of unilateral radical thyroidectomy and 18 cases of bilateral radical thyroidectomy.

Results: All surgeries were completed successfully. Compared with the conventional surgery group, the modified surgery group showed superior outcomes in terms of postoperative temporary recurrent laryngeal nerve palsy, the number of autologous parathyroid glands transplanted, and the number of lymph nodes dissected from the central compartment and level ⅣB (all P<0.05). And for patients undergoing unilateral radical thyroidectomy, operative time was shortened (P<0.05). As of May 25, 2026, the follow-up period ranged from 15 to 77 months; no adverse events such as recurrence of thyroid carcinoma were reported.

Conclusions: The modified en-bloc resection of thyroid carcinoma using recurrent laryngeal nerve tunnel dissection combined with mesothyroid excision is convenient to perform, achieves thorough lymph node dissection, and provides reliable protection of the recurrent laryngeal nerve and parathyroid glands, which is worthy of clinical application.