Predictors of Thyroid Gland Involvement in Hypopharyngeal Squamous Cell Carcinoma

Abstract

PurposeDecision to perform concurrent ipsilateral thyroidectomy on patients with hypopharyngeal cancer is important, and unnecessary thyroidectomy should be avoided if oncologically feasible. We hypothesized that concurrent ipsilateral thyroidectomy is not routinely required to prevent occult metastasis. This study aimed to determine the prevalence of histological thyroid invasion in patients with hypopharyngeal cancer, and to refine the indications for prophylactic ipsilateral thyroidectomy in patients with hypopharyngeal cancer.Materials and MethodsA retrospective review of the medical records from the Department of Otolaryngology at Yonsei University College of Medicine was conducted from January 1994 to December 2009. A total of 49 patients underwent laryngopharyngectomy with thyroidectomy as a primary treatment of hypopharyngeal cancer.ResultsThe incidence of thyroid gland involvement was 10.2%. The most common route of invasion was direct extension through the thyroid cartilage. Thyroid cartilage invasion (p=0.034) was the most significant factor associated with thyroid invasion. Disease-specific survival at 5 years was lower in patients with than without thyroid gland invasion (26.7% vs. 55.2%, respectively; p=0.032). Disease-free survival at 5 years was also lower in patients with than without thyroid gland invasion (20.0% vs. 52.1%, respectively; p=0.024).ConclusionIpsilateral thyroidectomy in combination with total laryngopharyngectomy is indicated when invasion of the thyroid cartilage is suspected in patients with hypopharyngeal cancer.

Refractory Thyrotoxicosis in Oropharyngeal Squamous Cell Carcinoma Invading the Thyroid Gland

“…The overall rate of thyroid invasion in head and neck SCC is likely higher as not all such cancers are treated by surgery, and thyroidectomy is not routinely performed even in the resection of these cancers (10-13). Moreover, thyroid function was not routinely reported in most studieswith occasional mention of patients being euthyroid or hypothyroid perioperatively (12)(13)(14). Thus, the rate of hyperthyroidism in patients with thyroid invasion secondary to head and neck SCC is unknown.…”

Total Laryngectomy: A Review of Surgical Techniques

“…In the past, ipsilateral hemithyroidectomy or total thyroidectomy was considered mandatory for all patients undergoing total laryngectomy [22]. However, several patients who underwent laryngectomies with partial preservation of the thyroid gland still developed hypothyroidism because the blood supply to the remnant thyroid gland was compromised during the operation [23]. Moreover, later studies have shown that thyroid gland invasion is uncommon [22][23][24].…”

The Incidence of Thyroid Gland Invasion in Patients with Carcinoma of the Larynx who Underwent Total Laryngectomy

“…Chang et al in a study of 49 patients with hypopharyngeal carcinoma found that preoperative CT imaging was the only statistically significant predictive factor for TGI (p=0.034). 19 Intraoperative assessment of the thyroid gland by palpation is also useful in detecting synchronous lesions involving the thyroid gland. 20 In our series, incidental presence of papillary thyroid carcinoma was found in 3 thyroid specimens.…”