The management of thyroid carcinoma invading the larynx or trachea

Honings, Jimmie; Stephen, Antonia E.; Marres, H.A.M.; Gaissert, Henning A.

doi:10.1002/lary.20800

Cited by 96 publications

(99 citation statements)

References 56 publications

(108 reference statements)

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“…they suggested that the upper respiratory tract should be sacrificed only if the tumor cannot be excised macroscopically. Gaissert et al [4][5][6] analyzed patients with thyroid carcinoma of different malignity grade and selectively performed radical tumorectomy in the patients with tracheal invasion. the postsurgical follow-up showed that 50 % of them survived for 20 years with good quality of life.…”

Section: Discussionmentioning

confidence: 99%

A review of the management and prognosis of thyroid carcinoma with tracheal invasion

Peng

Yang

et al. 2014

Eur Arch Otorhinolaryngol

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The objective of the study was to explore the surgical approaches, treatment significance and prognosis of thyroid carcinoma with tracheal invasion. We retrospectively reviewed 48 patients with tracheal invasion by papillary thyroid carcinoma, follicular thyroid carcinoma and medullary thyroid carcinoma by means of clinical data ranging from 1993 to 2011. The patients were classified into three groups in terms of the depth and extent of tracheal invasion by the tumors, i.e., group A of 18 patients with localized tracheal invasion; group B of 21 patients with intraluminal tracheal invasion, and group C of nine patients with extensive invasion of the trachea, larynx, esophagus and/or mediastinum. Of these patients, 18 received radical tumorectomy and segmental resection of the outer layer of the tracheal wall; 21 had radical tumorectomy, circumferential sleeve trachea resection or segmental tracheal resection plus tracheal repair, and the remaining nine patients underwent radical tumorectomy, segmental trachea resection and esophagolaryngectomy. 46 patients took I(131) oral solution and/or had external radiotherapy postoperatively. A survival analysis was done using Kaplan-Meier Estimator for cumulative survival probability together with Log-Rank test, and Cox Regression Model was used for multivariate analysis. (1) In group A of 18 patients, 10 took I(131)oral solution and 7 received radiotherapy after surgery. The overall 5 and 10-year survival rates were 88.93 and 77.78 %, respectively; (2) In group B of 21 patients, 15 took I(131) oral solution and 7 received radiotherapy after surgery. The overall 5 and 10-year survival rates were 90.47 and 61.87 %, respectively; (3) In group C of 9 patients, 7 received radiotherapy after surgery. The overall 5 and 10-year survival rates were 77.78 and 22.22 %, respectively. Whether they received postsurgical I(131) treatment or radiotherapy, there was a statistical difference between the 5-year survival rates and the 10-year survival rates in all of these three groups (P value in each group is <0.05). In the treatment of thyroid carcinoma with tracheal invasion, radical tumorectomy plus tracheal repair, segmental tracheal resection or circumferential sleeve trachea resection could lengthen the survival time. Radical tumorectomy could enhance the probability of survival of patients with thyroid carcinoma that had extensively invaded the larynx, esophagus and/or mediastinum. Postsurgical I(131) treatment and radiotherapy enhanced the probability of survival.

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Section: Discussionmentioning

confidence: 99%

A review of the management and prognosis of thyroid carcinoma with tracheal invasion

Peng

Yang

et al. 2014

Eur Arch Otorhinolaryngol

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“…The patients show symptoms according to the grade of their clinical invasion, although patients with intra-luminary invasions generally show dyspnea and hemoptysis. [12] Most of the cases with tracheal invasion represent superficial tracheal involvement and are first diagnosed during thyroidectomy. [13] Surgeons have to decide whether to perform a radical resection, including the trachea and/or larynx, or to perform limited resection with I131 or radiotherapy to ablate the residual disease.…”

Section: Discussionmentioning

confidence: 99%

“…The suggestion made in this report was that shave resection is incomplete, and a high rate of local failure must be expected. [12] Nishida et al [21] saw no indication for tracheal resection in those carcinomas that abutted the external perichondrium and performed a shave resection. Similarly, in this study, patients who had early stage (stage I according to Shin classification) laryngotracheal invasion did not show recurrence after shaving.…”

Section: Discussionmentioning

confidence: 99%

Management of advanced thyroid carcinoma with laryngotracheal invasion

Batıoğlu-Karaaltın¹

2017

Kulak Burun Bogaz Ihtis Derg

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Objectives: This study aims to evaluate the management of advanced thyroid carcinoma with extra-thyroidal extension. Patients and Methods:The study included 58 patients (26 males, 32 females; mean age 45.1±8.3 years; range 24 to 72 years) who were referred from general surgery or other otolaryngology departments and had undergone surgery for T4a well-differentiated thyroid carcinoma or T4b anaplastic carcinoma between January 2007 and January 2011 with a minimum of five years of follow-up. The patients with laryngotracheal invasion were divided into two groups according to type of surgery. Patterns of invasion and techniques of surgical resection were evaluated. Results:Of the patients in group 1 (n=24), total thyroidectomy was performed in all (100%), partial laryngectomy in six (10.4%), tracheal resection in eight (13%), and tracheal window resection in 16 (27%), and the free margins were verified by frozen section. Patients in group 2 (n=34) were performed total thyroidectomy (100%) by shaving the tumor off the underlying cartilage or skeletonizing laryngotracheal segments. During the follow-up period, one patient died because of carotid involvement and four patients died because of local recurrence. Conclusion:The results of this study suggest that the depth of the invasion and postoperative morbidity should be considered when choosing a surgical approach for patients with advanced thyroid carcinoma with extra-thyroidal extension. Also, patients who undergo tumor shaving should be followed-up closely.Keywords: Extra-thyroidal extension; segmental laryngotracheal resection; thyroid carcinoma. ÖZAmaç: Bu çalışmada ekstra tiroidal uzantılı ileri tiroid karsinomunun tedavisi değerlendirildi. Hastalar ve Yöntemler:Çalışmaya genel cerrahi veya diğer kulak-burun-boğaz bölümlerinden sevk edilen ve Ocak 2007 -Ocak 2011 tarihleri arasında T4a iyi diferansiye tiroid karsinomu veya T4b anaplastik karsinomu nedeniyle cerrahi geçiren, en az beş yıl takip edilen 58 hasta (26 erkek, 32 kadın; ort. yaş 45.1±8.3 yıl; dağılım 24-72 yıl) dahil edildi. Larengotrakeal invazyonu olan hastalar cerrahi türüne göre iki gruba ayrıldı. İnvazyon paternleri ve cerrahi rezeksiyon teknikleri değerlendirildi. Bulgular: Grup 1'deki hastaların (n=24) tamamına (%100) total tiroidektomi, altısına (%10.4) parsiyel larenjektomi, sekizine (%13) trakeal rezeksiyon ve 16'sına (%27) trakeal pencere rezeksiyonu uygulandı; serbest marjinler dondurulmuş kesit ile doğrulandı. Grup 2'deki hastalara (n=34) tümörü alttaki kıkırdaktan kazıyarak veya larengotrakeal segmentleri iskeletleştirerek total tiroidektomi (%100) uygulandı. Takip dönemi sırasında, bir hasta karotis tutulumu ve dört hasta lokal rekürens nedeniyle kaybedildi.Sonuç: Bu çalışmanın bulguları ekstra tiroidal uzantılı ileri tiroid karsinomlu hastalar için cerrahi bir yaklaşım seçilirken invazyon derinliğinin ve ameliyat sonrası morbiditenin dikkate alınması gerektiğini ortaya koymaktadır. Ayrıca, tümör kazıması geçiren hastalar yakından takip edilmelidir.Anahtar Sözcükler: Ekstra tiro...

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“…In this situation, determining the exact extent of invasion requires histopathological assessment that can only be achieved postoperatively. Therefore, some authors recommend a full-thickness excision including the mucosa of the airway (9,20,(33)(34)(35)(36)(37). This approach ensures a histologically negative margin but results in increased surgical complexity and significant functional impairment.…”

Section: Invasion Of the Airwaymentioning

confidence: 99%