Risk factors predisposing for recurrent laryngeal nerve palsy following thyroid malignancy surgery: experience from a tertiary oncology centre

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Abstract
Background Postoperative recurrent laryngeal nerve (RLN) palsy is one of the major morbidities encountered after thyroid surgery. The risk further increases when surgery is performed for thyroid malignancies. Methodology A retrospective study of patients who underwent hemi, total or completion thyroidectomy at our institute between June 2017 to May 2019 were analyzed. We assessed factors that predisposed to the development of RLN palsy. Results The study comprised of 228 patients. A total of 400 nerves were at risk. The RLN palsy rate was 6.8% (n = 27). On univariate and multivariate analysis, the risk of RLN palsy was seen most with pT4a tumor (OR = 8.5), gross extra-thyroidal extension (ETE) (OR = 3.5) and tracheo-esophageal groove (TEG) (OR = 2.8) involvement, followed by aggressive histopathology, and central compartment node positivity. Conclusion pT4a tumors, gross ETE, and TEG involvement were the leading causes predisposing for the development of RLN palsy in our series.

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