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Xie J, Liu H, Wu P, Chen L, Ge P, Chen S, Zhang S, Lu Z. Predictors of Thyroid Gland Invasion in Total Laryngectomy for Advanced Laryngeal Squamous Cell Carcinoma. EAR, NOSE & THROAT JOURNAL 2022:1455613221098300. [PMID: 35533678 DOI: 10.1177/01455613221098300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: Thyroidectomy for advanced laryngeal squamous cell carcinoma (LSCC) is controversial. This study aimed to identify predictors of thyroid gland invasion in patients with LSCC and management of the thyroid gland during total laryngectomy. Patients and Methods: Clinical data and pathological characteristics of 113 patients, who underwent laryngectomy with thyroidectomy for advanced LSCC in Guangdong Provincial People's Hospital between 2009 and 2019, were retrospectively analyzed. The incidence and predictors of thyroid gland invasion were analyzed, and a new predictor was proposed using a parallel test. Results: Of 113 patients, 25.7% exhibited thyroid invasion. A new predictor that combined the lower third of thyroid cartilage invasion and thyroid gland invasion on computed tomography/magnetic resonance imaging (CT/MRI) was associated with pathological thyroid gland invasion (P = 0.001; sensitivity, 88.2%; negative predictive value, 95%). Conclusion: Thyroidectomy may be required during total laryngectomy in those with invasion of the lower third of thyroid cartilage and/or thyroid gland invasion revealed on CT/MRI instead of being performed routinely.
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Affiliation(s)
- Jiaxuan Xie
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- 66477Shantou University Medical College, Shantou, China
| | - Hui Liu
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- 66477Shantou University Medical College, Shantou, China
| | - Peiyan Wu
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Liangsi Chen
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Pingjiang Ge
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shaohua Chen
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Siyi Zhang
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhongming Lu
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Xie J, Wu P, Liu H, Zhang S, Lu Z. Thyroid gland invasion in total laryngectomy: A systematic review and meta-analysis. Int J Surg 2022; 99:106262. [PMID: 35172203 DOI: 10.1016/j.ijsu.2022.106262] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/09/2021] [Accepted: 02/09/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although guidelines indicate that thyroidectomy should be performed routinely during total laryngectomy in patients with advanced laryngeal cancer, its clinical indications remain controversial. Some researchers believe that thyroid invasion is uncommon and that thyroid preservation should be considered in most cases. OBJECTIVE This study aimed to identify the incidence and predictors of thyroid invasion in patients with laryngeal cancer to facilitate decision-making regarding whether to perform thyroidectomy during total laryngectomy. MATERIALS AND METHODS The author conducted a systematic review and meta-analysis of all published articles retrieved from a search of the MEDLINE (1982-2020) and EMBASE (1971-2020) databases. The published studies of advanced laryngeal cancer with total laryngectomy and partial or total thyroidectomy for laryngeal cancer were selected. The incidence and predictors of thyroid invasion were analyzed. RESULTS We analyzed 25 studies (2177 cases), of which 176 people (8.08%) had thyroid invasion. Subglottic tumors (odds ratio [OR], 3.74; 95% CI, 1.75-7.99), T4 stage tumors (OR, 2.39; 95% CI, 1.20-4.75), subglottic extension (OR, 3.85; 95% CI,2.09-7.11), and thyroid cartilage invasion (OR, 3.98; 95% CI, 1.47-10.75) are risk factors for thyroid invasion, and no statistically significant difference was noted between recurrent tumor and thyroid invasion. CONCLUSION The risk of thyroid invasion was significantly higher when advanced laryngeal cancer involved subglottic tumors, T4 stage tumors, subglottic extension, and thyroid cartilage invasion. The overall incidence of thyroid gland invasion was low; therefore, thyroidectomy may be performed for cases deemed risky rather than as a routine measure of total laryngectomy. RESEARCH REGISTRY UIN: reviewregistry1226.
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Affiliation(s)
- Jiaxuan Xie
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China Shantou University Medical College, Shantou, Guangdong, China The Second School of Clinical Medicine, Southern Medical University, China
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Al-Hakami HA, Al Garni MA, AlSubayea H, AlOtaibi Y, Neazy A, Jameel W, Albouq M, Alnufaie A, Fatani N. The incidence of thyroid gland invasion in advanced laryngeal squamous cell carcinoma. Braz J Otorhinolaryngol 2021; 87:533-537. [PMID: 31879196 PMCID: PMC9422599 DOI: 10.1016/j.bjorl.2019.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 10/17/2019] [Accepted: 11/12/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction Invasion of the thyroid gland is not a general feature of advanced laryngeal carcinoma. There is no need for performing thyroidectomy in all total laryngectomy cases. Objectives To evaluate the frequency of the thyroid gland invasion in patients with advanced laryngeal squamous cell carcinoma submitted to total laryngectomy and thyroidectomy and to determine whether clinical and pathological characteristics of laryngeal carcinoma can predict glandular involvement. Methods A retrospective case series with chart review, from March 2009 to January 2018, was undertaken in the the Princess Norah Oncology Center, King Abdul-Aziz Medical City, Jeddah/KSA. An inception cohort of 56 patients with laryngeal squamous cell carcinoma was considered. Nine cases were excluded. All patients had advanced stage cancer of the larynx (clinically T3‒T4) and underwent total laryngectomy in association with thyroidectomy. Total thyroidectomy was performed in all bilateral lesions or if there was suspicion of contralateral lobe involvement. Hemithyroidectomy was performed in all lateralized lesions. Retrospective histopathologic analysis of thyroid specimens was subsequently performed. The frequency of thyroid gland invasion was calculated and analysis of demographic, clinical and pathological characteristics associated with thyroid gland invasion was performed. Results In all, 47 patients underwent total laryngectomy (40 treated with primary laryngectomy and seven treated with salvage laryngectomy following radiation failure or chemoradiation failure). Hemithyroidectomy was performed in 42 patients and the total thyroidectomy was performed in five patients. The overall frequency of invasion of the thyroid gland was 4.3%. Glandular involvement was seen in one advanced transglottic squamous cell carcinoma and one subglottic. In spite of thyroid cartilage invasion in 25.5% of cases detected in the preoperative radiological imaging, only one case demonstrated microscopic thyroid gland invasion. Conclusions Thyroidectomy may only be required during total laryngectomy for selected cases of advanced transglottic tumors and tumors with subglottic extension more than 10 mm.
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Affiliation(s)
- Hadi A Al-Hakami
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Department of Surgery, Section of Otolaryngology-Head & Neck Surgery, Jeddah, Saudi Arabia.
| | - Mohammed A Al Garni
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Department of Surgery, Section of Otolaryngology-Head & Neck Surgery, Jeddah, Saudi Arabia
| | - Haya AlSubayea
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Department of Surgery, Section of Otolaryngology-Head & Neck Surgery, Jeddah, Saudi Arabia
| | - Yazeed AlOtaibi
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Department of Surgery, Section of Otolaryngology-Head & Neck Surgery, Jeddah, Saudi Arabia
| | - A Neazy
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Department of Surgery, Section of Otolaryngology-Head & Neck Surgery, Jeddah, Saudi Arabia
| | - W Jameel
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Department of Surgery, Section of Otolaryngology-Head & Neck Surgery, Jeddah, Saudi Arabia
| | - Mohammed Albouq
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Department of Surgery, Section of Otolaryngology-Head & Neck Surgery, Jeddah, Saudi Arabia
| | - A Alnufaie
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Department of Surgery, Section of Otolaryngology-Head & Neck Surgery, Jeddah, Saudi Arabia
| | - Nawaf Fatani
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Department of Surgery, Section of Otolaryngology-Head & Neck Surgery, Jeddah, Saudi Arabia
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Baghel SS, Singhal P, Verma N, Sehra R, Yadav R, Agarwal S, Sharma MP, Gupta DP. Is thyroid excision mandatory with laryngectomy in carcinoma larynx? BMC Cancer 2020; 20:700. [PMID: 32723304 PMCID: PMC7389649 DOI: 10.1186/s12885-020-07205-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 07/22/2020] [Indexed: 11/30/2022] Open
Abstract
Background Advanced stage operable cancers of larynx are treated with total laryngectomy including thyroid resection in most of the cases, which may expose patient to hypothyroidism and hypoparathyroidism. The requirement of thyroidectomy during Total Laryngectomy is controversial. Methods A cross sectional observational study was set out to review preoperative clinical and radiological assessment; intraoperative and histopathological findings; and follow-up data to predict thyroid gland invasion in the setting of squamous cell carcinoma of the Larynx. Results 11 (16%) out of 69 patients had thyroid gland involvement on histopathological examination with mean age 63 years. Out of these 11 cases, 8 (72%) underwent primary total laryngectomy. 90% patients with thyroid gland involvement were male. 9 cases with thyroid gland involvement were staged as T4a preoperatively. Conclusion Invasion of thyroid gland by laryngeal cancer is uncommon. Unnecessary hemithyroidectomies lead to hypothyroidism and hypoparathyroidism. The study points out the clear indications of thyroid excision in patients undergoing total laryngectomy. We can suggest that total thyroidectomy should be done with total laryngectomy in cases which have gross clinical, radiological or intraoperative thyroid gland involvement, subglottic extension and thyroid cartilage invasion. This can save the patients from the brunt of unnecessary morbid hypothyroidism and hypoparathyroidism.
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Affiliation(s)
- Surendra Singh Baghel
- Department of Neuro-otology, Sanjay Gandhi Post Graduate Institute, Lucknow, Uttar Pradesh, India
| | - Pawan Singhal
- Department of ENT, SMS Medical College, Jaipur, 302004, Rajasthan, India.
| | - Namita Verma
- Department of ENT, SMS Medical College, Jaipur, 302004, Rajasthan, India
| | - Ritu Sehra
- Department of ENT, SMS Medical College, Jaipur, 302004, Rajasthan, India
| | - Rajeev Yadav
- Department of Preventive and Social Medicine, Department of Otorhinolaryngology, SMS Medical College, Jaipur, Rajasthan, India
| | - Sunita Agarwal
- Department of ENT, SMS Medical College, Jaipur, 302004, Rajasthan, India
| | - Man Prakash Sharma
- Department of ENT, SMS Medical College, Jaipur, 302004, Rajasthan, India
| | - D P Gupta
- Department of ENT, SMS Medical College, Jaipur, 302004, Rajasthan, India
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Thyroid Gland Involvement and the Efficiency of Thyroidectomy in Patients Having Larynx and Hypopharyngeal Cancers Treated with Surgery. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2019. [DOI: 10.5812/ijcm.88750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Does Thyroid Gland Preserving Total Laryngectomy Affect Oncological Control in Laryngeal Carcinoma? Laryngoscope 2019; 130:1465-1469. [DOI: 10.1002/lary.28235] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/27/2019] [Accepted: 07/23/2019] [Indexed: 11/07/2022]
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Management of the thyroid gland during laryngectomy. The Journal of Laryngology & Otology 2017; 131:740-744. [PMID: 28592347 DOI: 10.1017/s0022215117001244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This study aimed to: describe the incidence of thyroid gland involvement in advanced laryngeal cancer, analyse patterns of spread to the thyroid and elucidate predictors of thyroid involvement. METHODS A retrospective review was performed on patients who underwent laryngectomy from 1991 to 2015 as a primary or salvage treatment for squamous cell carcinoma of the larynx, hypopharynx or base of tongue. The incidence of thyroidectomy during total laryngectomy, type of thyroidectomy, incidence of gland involvement, route of spread, and positive predictors of spread were analysed and reported. RESULTS A total of 188 patients fit the inclusion criteria. Of these, 125 (66 per cent) underwent thyroidectomy. The thyroid was involved in 10 of the 125 patients (8 per cent), 9 by direct extension and 1 by metastasis. Cartilage invasion was a predictor of thyroid gland involvement, with a positive predictive value of 26 per cent. CONCLUSION There is a low incidence of thyroid gland involvement in laryngeal carcinoma. Most cases of gland involvement occurred by direct extension. Thyroidectomy during laryngectomy should be considered for advanced stage tumours with cartilage invasion.
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Mangussi-Gomes J, Danelon-Leonhardt F, Moussalem GF, Ahumada NG, Oliveira CL, Hojaij FC. Thyroid gland invasion in advanced squamous cell carcinoma of the larynx and hypopharynx. Braz J Otorhinolaryngol 2016; 83:269-275. [PMID: 27209377 PMCID: PMC9444747 DOI: 10.1016/j.bjorl.2016.03.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 03/23/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction Squamous cell carcinoma of the larynx and hypopharynx has the potential to invade the thyroid gland. Despite this risk, the proposition of either partial or total thyroidectomy as part of the surgical treatment of all such cases remains controversial. Objectives To evaluate the frequency of invasion of the thyroid gland in patients with advanced laryngeal or hypopharyngeal squamous cell carcinoma submitted to total laryngectomy or pharyngolaryngectomy and thyroidectomy; to determine whether clinic-pathological characteristics can predict glandular involvement. Methods A retrospective case series with chart review, from January 1998 to July 2013, was undertaken in a tertiary care university medical center. An inception cohort of 83 patients with larynx/hypopharynx squamous cell carcinoma was considered. All patients had advanced stage disease (clinically T3–T4) and underwent total laryngectomy or total pharyngolaryngectomy in association with thyroidectomy. Adjuvant therapy was indicated when tumor or neck conditions required. Frequency of thyroid cartilage invasion was calculated; univariate and multivariate analysis of demographic, clinical and pathological characteristics associated with cartilage invasion were performed. Results The overall frequency of invasion of the thyroid gland was 18.1%. Glandular involvement was associated with invasion of the following structures: anterior commissure (odds ratio = 5.13; 95% confidence interval 1.07–24.5), subglottis (odds ratio = 12.44; 95% confidence interval 1.55–100.00) and cricoid cartilage (odds ratio = 15.95; 95% confidence interval 4.23–60.11). Conclusions Invasion of the thyroid gland is uncommon in the context of laryngopharyngeal squamous cell carcinoma. Clinical and pathological features such as invasion of the anterior commissure, subglottis and cricoid cartilage are more associated with glandular invasion.
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Affiliation(s)
- João Mangussi-Gomes
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Fernando Danelon-Leonhardt
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil.
| | - Guilherme Figner Moussalem
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Nicolas Galat Ahumada
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Cleydson Lucena Oliveira
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Flávio Carneiro Hojaij
- Universidade Federal de São Paulo, Departamento de Otorrinolaringologia Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil; Universidade de São Paulo, Laboratório de Pesquisas Clínicas - LIM-32, São Paulo, SP, Brazil
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Management of thyroid gland invasion in laryngeal and hypopharyngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol 2015; 273:511-5. [DOI: 10.1007/s00405-015-3828-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
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Thyroid gland involvement in carcinoma of the hypopharynx. The Journal of Laryngology & Otology 2014; 128:64-7. [DOI: 10.1017/s0022215113003277] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:The thyroid gland is removed en bloc during laryngectomy. There are no objective criteria for deciding the extent of thyroid gland resection in primary hypopharyngeal cancer cases. The present study aimed to determine the incidence of thyroid gland involvement in hypopharyngeal cancer and identify the various predictors of this involvement.Method:This paper reports a retrospective analysis of 358 patients with hypopharyngeal cancer, who underwent total laryngectomy with partial or total pharyngectomy at Tata Memorial Hospital, Mumbai between 2004 and 2010.Results:The mean age of this population was 61 years. The pyriform sinus was the most common hypopharyngeal subsite involved (in 89 per cent of cases). Most patients underwent hemi-thyroidectomy as part of their surgery. The thyroid gland was involved in only 13 per cent of cases.Conclusion:Thyroid gland involvement is not common in hypopharyngeal cancer. Cases that involved the post-cricoid area, subglottic extension, extralaryngeal spread or prior tracheostomy were associated with a higher risk of thyroid gland involvement. Ipsilateral thyroidectomy is sufficient in most patients undergoing surgery (laryngectomy with partial or total pharyngectomy) for hypopharyngeal cancers.
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