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Cervical exenteration and its variants for locally advanced thyroid cancer: when, why, and how? Curr Opin Otolaryngol Head Neck Surg 2023; 31:65-72. [PMID: 36912217 DOI: 10.1097/moo.0000000000000873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
PURPOSE OF REVIEW To describe the modern surgical approach for management of advanced thyroid cancers infiltrating the cervicovisceral axis with special attention to well differentiated tumors not amenable to organ-sparing techniques. In particular, cervical exenteration, herein defined as the sum of total thyroidectomy, central compartment and lateral neck dissections, variously associated with total laryngectomy and possible partial or total pharyngoesophagectomy, represents an extreme surgical procedure that, in properly selected cases, allows for reasonable palliation of central compartment life-threatening signs/symptoms if not cure for an advanced oncologic condition. RECENT FINDINGS Cervical exenteration is not contraindicated by the presence of limited distant metastases at presentation. Even though it requires that the patient is in general good health as it can be associated with a number of complications and long in-hospital stay, when appropriately planned and performed according to the most recent reconstructive nuances, it allows good oncologic outcomes that are not inferior to those described for similarly advanced primaries of the upper aerodigestive tract. In addition, quality of life and functional results are not significantly different from those described after total laryngectomy for primary laryngeal squamous cell carcinomas. SUMMARY Cervical exenteration requires a tertiary, expert, multidisciplinary effort in terms of diagnosis, surgical performance, and postoperative care. A patient-centered decision process is strongly warranted taking into consideration alternative therapeutic and symptom-based palliative strategies.
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Park JO, Kim JH, Joo YH, Kim SY, Kim GJ, Kim HB, Lee DH, Hong HJ, Park YM, Chung EJ, Ji YB, Oh KH, Lee HS, Lee DK, Park KN, Ban MJ, Kim BH, Kim DH, Cho JK, Ahn DB, Kim MS, Seok JG, Jang JY, Choi HG, Kim HJ, Park SJ, Jung EK, Kim YS, Hong YT, Lee YC, Won HR, Shin SC, Baek SK, Kwon SY. Guideline for the Surgical Management of Locally Invasive Differentiated Thyroid Cancer From the Korean Society of Head and Neck Surgery. Clin Exp Otorhinolaryngol 2023; 16:1-19. [PMID: 36634669 PMCID: PMC9985989 DOI: 10.21053/ceo.2022.01732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/11/2023] [Indexed: 01/12/2023] Open
Abstract
The aim of this study was to develop evidence-based recommendations for determining the surgical extent in patients with locally invasive differentiated thyroid cancer (DTC). Locally invasive DTC with gross extrathyroidal extension invading surrounding anatomical structures may lead to several functional deficits and poor oncological outcomes. At present, the optimal extent of surgery in locally invasive DTC remains a matter of debate, and there are no adequate guidelines. On October 8, 2021, four experts searched the PubMed, Embase, and Cochrane Library databases; the identified papers were reviewed by 39 experts in thyroid and head and neck surgery. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence, and to develop and report recommendations. The strength of a recommendation reflects the confidence of a guideline panel that the desirable effects of an intervention outweigh any undesirable effects, across all patients for whom the recommendation is applicable. After completing the draft guidelines, Delphi questionnaires were completed by members of the Korean Society of Head and Neck Surgery. Twenty-seven evidence-based recommendations were made for several factors, including the preoperative workup; surgical extent of thyroidectomy; surgery for cancer invading the strap muscles, recurrent laryngeal nerve, laryngeal framework, trachea, or esophagus; and surgery for patients with central and lateral cervical lymph node involvement. Evidence-based guidelines were devised to help clinicians make safer and more efficient clinical decisions for the optimal surgical treatment of patients with locally invasive DTC.
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Affiliation(s)
- Jun-Ook Park
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joo Hyun Kim
- Department of Otolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Young Hoon Joo
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang-Yeon Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Geun-Jeon Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Bum Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong-Hyun Lee
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Jun Hong
- Department of Otolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Young Min Park
- Department of Otolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Eun-Jae Chung
- Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yong Bae Ji
- Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Kyoung Ho Oh
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hyoung Shin Lee
- Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Dong Kun Lee
- Department of Otolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Ki Nam Park
- Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Asan, Korea
| | - Myung Jin Ban
- Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Asan, Korea
| | - Bo Hae Kim
- Department of Otolaryngology-Head and Neck Surgery, Dongguk University College of Medicine, Goyang, Korea
| | - Do Hun Kim
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Inje University, Busan, Korea
| | - Jae-Keun Cho
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Inje University, Busan, Korea
| | - Dong Bin Ahn
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Min-Su Kim
- Department of Otolaryngology-Head and Neck Surgery, CHA University School of Medicine, Seongnam, Korea
| | - Jun Girl Seok
- Department of Otolaryngology-Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Jeon Yeob Jang
- Department of Otolaryngology-Head and Neck Surgery, Ajou University School of Medicine, Suwon, Korea
| | - Hyo Geun Choi
- Department of Otolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Hee Jin Kim
- Department of Otolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Sung Joon Park
- Department of Otolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Eun Kyung Jung
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School, Kwangju, Korea
| | - Yeon Soo Kim
- Department of Otolaryngology-Head and Neck Surgery, Konyang University College of Medicine, Daejeon, Korea
| | - Yong Tae Hong
- Department of Otolaryngology-Head and Neck Surgery, Jeonbuk National University Medical School, Jeonju, Korea
| | - Young Chan Lee
- Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Ho-Ryun Won
- Department of Otolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Korea
| | - Sung-Chan Shin
- Department of Otolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Yangsan, Korea
| | - Seung-Kuk Baek
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Soon Young Kwon
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
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Parida PK, Herkal K, Preetam C, Pradhan P, Samal DK, Sarkar S. Analysis of Pattern of Laryngotracheal Invasion by Papillary Thyroid Carcinoma and Their Management: Our Experience. Indian J Otolaryngol Head Neck Surg 2022; 74:1920-1928. [PMID: 36452820 PMCID: PMC9702032 DOI: 10.1007/s12070-020-01914-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/13/2020] [Indexed: 11/28/2022] Open
Abstract
To analyse the pattern of laryngotracheal invasion (LTI) by papillary-thyroid-carcinoma (PTC) and outcomes of their management. We undertook a retrospective chart review to study patterns of LTI by PTC and to evaluate outcomes of surgical modalities used to treat PTC with LTI. Out of 246cases of PTC, 26-cases had LTI (male-12, female-14, mean-age-55.6 years, range 42-73 years). Common clinical presentation were neck swelling, respiratory distress/stridor and vocal cord paralysis in 100%, 8 (30.8%) and 10 (38.5%) cases respectively. PTC was staged according to AJCC-TNM staging system (T4a-24, T4b-02, N1a-12, N1b-14, M0-25, and M1-01). CT-scan showed obvious LTI and tracheal narrowing in 11(42.3%) and 18(69.2%) cases respectively. All cases underwent total thyroidectomy with central-compartment-clearance. Unilateral and bilateral lateral-neck-dissection was performed in 08 and 06cases respectively. Pattern of Intra-operative LTI were as follows: trachea-13cases, trachea and cricoid-05cases, thyroid cartilage-6cases, trachea, cricoid and thyroid cartilage-2 cases and intra-luminal involvement in 4cases. Modified Shin's staging was used to stage LTI. LTI were superficial, deep-extra-luminal and intra-luminal in 13, 09 and 04cases respectively. LTI was managed by shave-excision, window-resection of trachea, sleeve-resection of trachea and anastomosis, partial laryngectomy and total-laryngectomy in 13,02,04,05 and 2 cases respectively. All patients received radio-active-iodine (RAI) and TSH-suppression-therapy post-operatively. Mean follow-up period was two-years (range 18-30 months). One-case had radio-iodine non-avid local recurrence with lung metastases one-year post-operatively. Shave-excision is adequate for tumours not infiltrating into outer perichondrium. Tracheal-resection and total/partial laryngectomy may be required in cases with laryngo-tracheal cartilage or intra-luminal involvement. Adequate surgical excision along with postoperative RAI and TSH-suppression-therapy gives good loco-regional disease control in PTC with LTI.
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Affiliation(s)
- Pradipta Kumar Parida
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences, Sijua, Patrapara, Bhubaneswar, Odisha 751020 India
| | - Karthik Herkal
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences, Sijua, Patrapara, Bhubaneswar, Odisha 751020 India
| | - Chapity Preetam
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences, Sijua, Patrapara, Bhubaneswar, Odisha 751020 India
| | - Pradeep Pradhan
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences, Sijua, Patrapara, Bhubaneswar, Odisha 751020 India
| | - Dillip Kumar Samal
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences, Sijua, Patrapara, Bhubaneswar, Odisha 751020 India
| | - Saurav Sarkar
- Department of ENT and Head Neck Surgery, All India Institute of Medical Sciences, Sijua, Patrapara, Bhubaneswar, Odisha 751020 India
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Surgical Treatment of Advanced Thyroid Cancer with Tracheal Invasion. Case Rep Endocrinol 2021; 2021:8823405. [PMID: 33564480 PMCID: PMC7867464 DOI: 10.1155/2021/8823405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 01/02/2021] [Accepted: 01/21/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Tracheal invasion in thyroid cancer occurs in one-third of locally advanced cases and is the third most common site of infiltration following strap muscles and recurrent laryngeal nerves. Surgical resection plays an important role in the management strategy followed by either radioactive iodine or external beam radiotherapy. Nonetheless, there has been still controversy about the optimal extension of the surgery. Case Presentation. Total thyroidectomy, airway resection and bilateral neck dissection were performed in two cases diagnosed as advanced thyroid cancer with tracheal invasion (stage IV according to McCaffrey). The first case underwent partial tracheal resection and direct anastomosis by the V-shape technique, while the latter one required tracheal resection and permanent tracheotomy. After one-year follow-up, no evidence of tumor recurrence or any postoperative complications were found. Conclusion Surgical resection still remains the mainstay of management for advanced thyroid cancer in general and for tracheal invasion cases in particular. The decision of surgical resection and tracheal reconstruction methods mostly depends on the extent of tracheal invasion.
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Flukes S, Cohen MA, Cunningham LM, Wong RJ, Cracchiolo JR. Oncologic and functional outcomes following laryngectomy for locally advanced thyroid cancer. J Surg Oncol 2020; 123:149-155. [PMID: 33063318 DOI: 10.1002/jso.26257] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 10/03/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES Total laryngectomy in thyroid cancer is controversial. Functional and oncologic outcomes are needed to inform surgical indications in this population. METHODS A retrospective cohort study was performed at a tertiary referral center from 1997 to 2018 to identify patients with a diagnosis of thyroid carcinoma who underwent total laryngectomy. Complications, survival outcomes, and functional outcomes were analyzed. RESULTS Thirty patients met the inclusion criteria. The mean age was 62 years (range, 30-88 years) and the male-to-female ratio was 1:2.75. The most common diagnosis was well-differentiated thyroid cancer (53.3%), followed by poorly differentiated (30%) and anaplastic (16.7%). Total laryngectomy was performed with a 10% rate of Clavien-Dindo Grade III-V complications. The median overall survival was 40 months (range, 1-237). Five-year overall survival was 39.5% and disease-specific survival was 51.1%. Locoregional control was achieved in 80.0% of patients. Twelve months postoperatively, 100% of surviving patients were taking oral intake and 86.4% had a self-reported functional voice. CONCLUSION Total laryngectomy for locally advanced thyroid cancer is safe and provides acceptable rates of locoregional control. While the risk of distant metastases remains high, advances in systemic therapy may justify aggressive local control strategies to improve the quality of life.
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Affiliation(s)
- Stephanie Flukes
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Marc A Cohen
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Louise M Cunningham
- Speech and Language Pathology, Speech and Hearing Center, Rehabilitation Services, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Richard J Wong
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Jennifer R Cracchiolo
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
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6
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Roka R. Surgical treatment of locally advanced thyroid cancer. Innov Surg Sci 2020; 5:27-34. [PMID: 33506091 PMCID: PMC7798306 DOI: 10.1515/iss-2020-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/14/2020] [Indexed: 11/15/2022] Open
Abstract
Operations in this area are demanding and require special experience in endocrine, thoracic and vascular surgery, an experienced anaesthesiologist, as well as the interdisciplinary cooperation with other medical specialists (nuclear medicine, oncology, radiology, otolaryngology). A reliable system of surgical guidelines has been developed from a few individual publications with special impact.
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Affiliation(s)
- Rudolf Roka
- Acute and Endocrine Surgery, Sigmund Freud Private University Vienna, Wien, Austria
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7
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Chala AI, Vélez S, Sanabria A. The role of laryngectomy in locally advanced thyroid carcinoma. Review of 16 cases. ACTA ACUST UNITED AC 2019; 38:109-114. [PMID: 29967549 DOI: 10.14639/0392-100x-1191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 03/11/2017] [Indexed: 11/23/2022]
Abstract
SUMMARY Locally advanced disease with larynx invasion is a challenge to the surgeon, but laryngectomy is almost never necessary in thyroid carcinoma. The aim of this study was to review the clinical outcomes of patients with locally advanced thyroid carcinoma invading the larynx who underwent laryngectomy. A case series of patients treated in a tertiary care hospital was reviewed. Data about the type of operation, method of reconstruction, complications and overall survival of 16 patients operated on between 2002 and 2015 with larynx invasion is presented. There were 10 females. The mean age was 63 ± 8.8 years. Besides total thyroidectomy and neck dissection, four patients underwent total pharyngolaryngectomy, 11 total laryngectomy and one hemi-laryngectomy. Reconstruction was made with regional flaps in 10 patients (7 pectoral/Bakamjian flaps and 3 gastric pull-through procedures) and a jejunum free flap in one patient. Two patients needed carotid artery reconstruction. Five tumours were classic (conventional) papillary carcinoma variants, while the others were aggressive histological varieties (insular, tall cell, sclerosing). The mean tumour size was 4.3 ± 1.6 cm. All tumours had lymphovascular invasion and 12 had positive lymph nodes. Concomitantly, oesophageal/hypopharyngeal invasion was present in 7 cases and invasion of carotid vessels in 2 cases. There were two postoperative deaths and two anastomotic leaks that were treated conservatively. The mean overall survival was 31 ± 33 months (median 27.6 months, range 0-120). Laryngectomy is an alternative surgical procedure to control selected cases of advanced thyroid carcinoma that offers good local control and long term survival.
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Affiliation(s)
- A I Chala
- Head and Neck Surgery Service, School of Medicine, Universidad de Caldas, Manizales, Colombia
| | - S Vélez
- School of Medicine. Universidad de Antioquia, Medellín, Colombia
| | - A Sanabria
- School of Medicine, Universidad de Antioquia, Fundación Colombiana de Cancerología Clínica Vida, Medellín, Colombia
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Madariaga ML, Gaissert HA. Secondary tracheal tumors: a systematic review. Ann Cardiothorac Surg 2018; 7:183-196. [PMID: 29707496 PMCID: PMC5900082 DOI: 10.21037/acs.2018.02.01] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 12/21/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Secondary tracheal tumors arise from mural invasion by primary tumors in adjacent organs, metastatic lymph nodes or blood-born metastasis from distant sites. This systematic review aims to assess the presentation, management options, and clinical outcomes of these uncommon non-tracheal malignancies. METHODS Electronic searches of the MEDLINE database were performed to identify case series and individual case reports of tracheal invasion by primary non-tracheal tumors or metastatic disease. All English-language studies with available abstracts or articles containing primary data were included. RESULTS From 1978 to 2017, a total of 160 case reports or case series identified 2,242 patients with invasion of the trachea by tumors of adjacent organs (n=1,853) or by metastatic lymph nodes or hematogenous spread (n=389). Common primary sites of origin were thyroid, esophagus, and lung, and the most common presentation was metachronous (range of interval: 0 to 564 months) with dyspnea, neck mass, voice change and/or hemoptysis. A majority of patients in case reports (77.9%) and case series (66.0%) underwent resection and the most common reported operation was segmental tracheal resection. Fewer patients underwent bronchoscopic intervention (21.7%) and radiation was used in 32.2% of patients. Complications after bronchoscopic treatment included bleeding, granulation tissue, and retained secretions, while anastomotic leak, unplanned tracheostomy, and new recurrent laryngeal nerve paralysis were observed after surgical resection. The rate of 30-day mortality was low (0.01-1.80%). Median survival was higher in patients with thyroid malignancy and in patients who underwent surgical management. Follow-up time ranged from 0.03 to 183 months. CONCLUSIONS Patients with tracheal invasion by metastatic or primary non-tracheal malignancies should be assessed for symptoms, tumor grade, tumor recurrence and concurrent metastases to decide on optimal surgical, bronchoscopic or noninterventional therapy. Clinical experience suggests that palliative endoscopic intervention for tracheal obstruction by metastasis-bearing lymph nodes is underreported.
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Affiliation(s)
- Maria Lucia Madariaga
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Henning A Gaissert
- Division of Thoracic Surgery, Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
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9
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Georgiades F, Vasiliou G, Kyrodimos E, Thrasyvoulou G. Extensive laryngeal infiltration from a neglected papillary thyroid carcinoma: A case report. World J Clin Cases 2016; 4:187-190. [PMID: 27458595 PMCID: PMC4945590 DOI: 10.12998/wjcc.v4.i7.187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/28/2016] [Accepted: 05/27/2016] [Indexed: 02/05/2023] Open
Abstract
Papillary carcinoma of the thyroid is the commonest type of thyroid cancer. Laryngeal infiltration from papillary thyroid carcinoma is extremely rare, with only a few cases of partial invasion described in the literature. We present a very unusual case of complete infiltration of both thyroid and cricoid cartilages from a neglected papillary thyroid carcinoma in a 59-year-old male. This sequel resulted from refusal of the patient to undergo treatment when initially diagnosed. An invasion to such an extent has not been described in the literature before, and in this case warranted a total laryngectomy followed by radioactive iodine. Prompt management of papillary carcinomas is crucial for avoiding such complications. Future guidelines should include management options for the patients who deny treatment initially.
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Mossetti C, Palestini N, Bruna MC, Camandona M, Freddi M, Oliaro A, Gasparri G. Segmental tracheal resection for invasive differentiated thyroid carcinoma. Our experience in eight cases. Langenbecks Arch Surg 2013; 398:1075-82. [DOI: 10.1007/s00423-013-1127-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022]
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11
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Airtight Tracheocutaneostomy After Window Resection of the Trachea for Invasive Papillary Thyroid Carcinoma: Experience of 109 Cases. World J Surg 2013; 38:660-6. [DOI: 10.1007/s00268-013-2197-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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12
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Brauckhoff M, Dralle H. [Extrathyroidal thyroid cancer : results of tracheal shaving and tracheal resection]. Chirurg 2011; 82:134-40. [PMID: 21153528 DOI: 10.1007/s00104-010-1975-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Extrathyroidal thyroid cancer invading the laryngotracheal system (UICC stage pT4a) represents a progressive process of infiltration of the tracheal wall layers from the outer to the inner parts of the trachea. These tumors usually present with high proliferation activity correlating with a reduced long-term prognosis. In contrast to intraluminal manifestation requiring complete wall resection, in cases of non-transmural invasion, complete tumor removal can be sometimes achieved by extraluminal tangential resection (shaving). Tangential resections, however, are associated with a higher frequency of microscopically invaded resection margins (R1 resection rate >40%). The available comparative studies (all retrospective, maximum EBM level 3) analyzing oncological outcome show inconsistent results. In more recently published studies, however, complete wall resection in well-differentiated thyroid cancer with tracheal invasion only was found to be associated with longer recurrence-free and tumor-specific survival when compared to shaving. Deep larynx invasion is associated with reduced long-term prognosis when compared to invasion of the trachea. Salvage resections should therefore be performed in selected cases only.
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Affiliation(s)
- M Brauckhoff
- Department of Surgical Sciences, University of Bergen, Norway.
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13
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Honings J, Stephen AE, Marres HA, Gaissert HA. The management of thyroid carcinoma invading the larynx or trachea. Laryngoscope 2010; 120:682-9. [PMID: 20213659 DOI: 10.1002/lary.20800] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe the controversies in the management of thyroid carcinoma invading the airway. STUDY DESIGN Contemporary review of literature; level of evidence: 5. RESULTS Invasion of the larynx or trachea by thyroid carcinoma is uncommon and often identified at the time of operation, when the surgeon must decide the extent of resection. Invasion of the airway is associated with loss of tumor differentiation and a reduction in long-term survival compared to tumors limited to the thyroid gland. Whether or not the invaded airway should be resected remains controversial. Tangential shave excision of tumor is commonly performed, despite a marked risk of local recurrence. Circumferential sleeve resection of the larynx and trachea is safe and lowers the risk of local recurrence. In recurrent disease, laryngotracheal resection provides effective palliation of airway obstruction and hemoptysis. CONCLUSIONS Long-term (>10-20 years) prospective studies are required to compare the outcome after shave excision with segmental airway resection for thyroid carcinoma. Based on the current literature and on our experience, we advocate circumferential tracheal resection in the setting of airway involvement.
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Affiliation(s)
- Jimmie Honings
- Division of Thoracic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA
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14
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Ito Y, Fukushima M, Yabuta T, Tomoda C, Inoue H, Kihara M, Higashiyama T, Uruno T, Takamura Y, Miya A, Kobayashi K, Matsuzuka F, Miyauchi A. Local Prognosis of Patients with Papillary Thyroid Carcinoma who were Intra-operatively Diagnosed as Having Minimal Invasion of the Trachea: A 17-year Experience in a Single Institute. Asian J Surg 2009; 32:102-8. [DOI: 10.1016/s1015-9584(09)60019-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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15
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Price DL, Wong RJ, Randolph GW. Invasive thyroid cancer: management of the trachea and esophagus. Otolaryngol Clin North Am 2009; 41:1155-68, ix-x. [PMID: 19040976 DOI: 10.1016/j.otc.2008.08.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Well-differentiated thyroid cancer most commonly presents as an intrathyroidal tumor; however, extrathyroidal extension occurs in approximately 6% to 13% of patients and carries a significant negative impact on survival. Extrathyroidal disease may involve critical structures in the central neck, including the recurrent laryngeal nerves, trachea, esophagus, and larynx, requiring surgery extending significantly beyond the thyroid gland. Appropriate surgical management is of great importance and can normalize survival curves, whereas gross residual disease postoperatively may lead to recurrence and decreased survival. Adjuvant postoperative therapies for thyroid cancers with extrathyroidal extension include thyroid hormone suppression, radioactive iodine therapy, and external beam radiotherapy. This summary reviews approaches to the management of invasive thyroid cancers involving the aerodigestive tract.
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Affiliation(s)
- Daniel L Price
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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Ark N, Zemo S, Nolen D, Holsinger FC, Weber RS. Management of locally invasive well-differentiated thyroid cancer. Surg Oncol Clin N Am 2008; 17:145-55, ix. [PMID: 18177804 DOI: 10.1016/j.soc.2007.10.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Thyroid carcinoma invasion of the aerodigestive tract and recurrent laryngeal nerve (RLN) are important factors with increase in morbidity and mortality. Primary treatment is surgery; the decision about the extent of surgery is difficult, because preserving function is as essential as removal of the tumor. This article discusses the literature relating to the assessment of disease, surgical management, and adjuvant therapy for invasive thyroid cancer of the aerodigestive tract and RLN and makes suggestions based on the authors' experience.
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Affiliation(s)
- Nebil Ark
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA
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17
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Weigel RJ. Thyroid. Surgery 2008. [DOI: 10.1007/978-0-387-68113-9_57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Abstract
While most thyroid cancers are slow-growing and have an excellent prognosis after appropriate treatment, a subset of thyroid cancers behave aggressively, and approximately 1500 individuals in the US will die of the disease in the year 2007. Advanced thyroid malignancies can cause distressing and life-threatening symptoms by local invasion in the neck, growth of distant metastases in the lung, bone, and other organs, and tumor production of bioactive substances in the case of medullary thyroid cancer. This article will review palliative modalities, including surgery, radioactive iodine, external beam radiation, and chemotherapy, as well as novel targeted therapies, for the treatment of patients with advanced thyroid malignancies.
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Affiliation(s)
- David Yü Greenblatt
- Department of Surgery, Section of Endocrine Surgery, University of Wisconsin, H4/750 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA
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19
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Brauckhoff M, Meinicke A, Bilkenroth U, Lorenz K, Brauckhoff K, Gimm O, Thanh PN, Dralle H. Long-term results and functional outcome after cervical evisceration in patients with thyroid cancer. Surgery 2007; 140:953-9. [PMID: 17188144 DOI: 10.1016/j.surg.2006.09.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Revised: 09/13/2006] [Accepted: 09/25/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical strategy in patients with thyroid cancer (TC) infiltrating the aerodigestive system is controversial. This study was undertaken to examine the long-term results of cervical evisceration (CE). PATIENTS AND METHODS Since 1995, 14 consecutive patients with advanced TC underwent total laryngectomy (LE, n = 6) or esophagolaryngectomy (ELR, n = 8). Patients with unusual thyroid neoplasms or metastases to the thyroid (n = 3) were excluded. For esophageal reconstruction, free jejunal grafts (n = 6) and gastric tubes (n = 2) were used. RESULTS Procedure-related morbidity and mortality were 42% and 14%, respectively. ELR was associated with a significant higher frequency of complications and reoperations compared with LE. Twelve-month and 30-month survival rates were 73% and 55%, respectively; 85% of the patients were satisfied with the surgical results. There were no long-term problems concerning food intake in the ELR patients. Two ELR patients were able to learn a substitutive voice. CONCLUSIONS Cervical evisceration in patients with TC is associated with significant perioperative morbidity and mortality requiring careful patient selection. Regarding long-term survival, local tumor control, and patient's satisfaction, however, CE should be taken into account in suitable patients with advanced TC.
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Affiliation(s)
- Michael Brauckhoff
- Department of General, Visceral, and Vascular Surgery, Halle/Saale, Germany.
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20
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Wada N, Nakayama H, Masudo Y, Suganuma N, Rino Y. Clinical outcome of different modes of resection in papillary thyroid carcinomas with laryngotracheal invasion. Langenbecks Arch Surg 2006; 391:545-9. [PMID: 17043903 DOI: 10.1007/s00423-006-0106-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2006] [Accepted: 08/25/2006] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study is to evaluate the outcome of different modes of resection in papillary thyroid carcinoma (PTC) with laryngotracheal invasion. MATERIALS AND METHODS Sixty-four primary PTCs with laryngotracheal invasion between 1964 and 2003 were retrospectively analyzed (17 men and 47 women; mean age, 61.6 years; mean follow-up, 92.3 months). Thirteen curative resections included six pharyngolaryngoesophagectomies, two total laryngectomies, and five circumferential resections (complete surgery). Eighteen patients who were candidates for curative resection refused to undergo complete surgery to avoid functional impairment, especially laryngeal function (incomplete surgery). Thirty-three patients with minimal invasion underwent shave or partial resection (conservative surgery). Clinical outcomes were compared between the three groups. The influence of different types of surgery and invasion was also evaluated by Cox proportional hazard analysis. RESULTS Three (23.1%) complete, 17 (94.4%) incomplete, and 4 (13.8%) conservative surgery patients died of disease (P < 0.0001). The 10-year disease-specific survival (Kaplan-Meier) in complete, incomplete, and conservative surgery patients were 62.9, 11.1, and 87.7%, respectively (log rank test, P < 0.0001). Incomplete surgery related to worse prognosis [p < 0.0001; hazard ratio (HR), 12.9) than complete or conservative surgery. Tracheal deep invasion (p = 0.0019, HR 7.6) and larynx invasion (p < 0.0001, HR 9.9) related to worse prognosis than minimal invasion. CONCLUSION Curative resection improves clinical outcomes in PTCs with laryngotracheal invasion. Conservative resection for minimal invasion also can achieve favorable prognosis. The degree of tumor invasion is significantly related to survival.
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Affiliation(s)
- Nobuyuki Wada
- Department of General Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku Yokohama, Kanagawa 236-0004, Japan.
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21
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Miloundja J, Lescanne E, Ouedraogo B, Pondaven S, Beutter P, Morinière S. [Differenciated thyroid carcinomas with laryngo-tracheal invasion]. ACTA ACUST UNITED AC 2006; 123:34-40. [PMID: 16609667 DOI: 10.1016/s0003-438x(06)76636-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Analyze the diagnosis and treatment of differentiated thyroid carcinomas with laryngo-tracheal invasion. MATERIALS AND METHODS Among the 117 patients operated for a differentiated thyroid carcinoma in the ENT department of Tours Hospital (France) between January 1990 and December 2003, seven presented laryngo-tracheal invasion and were included in this retrospective study. RESULTS Laryngo-tracheal resection resulted in a thyroid cartilage-shaving in two patients. We performed a resection of one side of the thyroid cartilage in one patient, a thyro-tracheal resection-anastomosis with a partial cricoidectomy in one patient, a partial vertical laryngectomy extended to the first tracheal ring in one patient and a total laryngectomy in one patient. No laryngo-tracheal resection was done in one patient. Early complications were swallowing disorders (n = 2), transitory hypoparathyroidism (n = 1), definitive recurrent nerve paralysis (n = 2), subcutaneous emphysema and hematoma (n = 1) and Claude Bernard-Horner's syndrome (n = 1). Locoregional recurrences (n = 2) and distant metastasis (n = 2) were discovered six months to four years after the laryngo-tracheal resection. With a mean follow-up of 40 month, four patients were alive (two disease free) two patients had died and one was lost of follow-up at three months. CONCLUSION The frequency of locoregional recurrences and distant metastasis is higher for the differentiated thyroid carcinomas with laryngo-tracheal invasion than the others. In these cases, we performed macroscopic carcinological surgery preserving laryngeal functions as much as possible.
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Affiliation(s)
- J Miloundja
- Service d'ORL et de chirurgie cervico-faciale, Hôpital Bretonneau, CHU de Tours
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22
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Randolph GW, Kamani D. The importance of preoperative laryngoscopy in patients undergoing thyroidectomy: Voice, vocal cord function, and the preoperative detection of invasive thyroid malignancy. Surgery 2006; 139:357-62. [PMID: 16546500 DOI: 10.1016/j.surg.2005.08.009] [Citation(s) in RCA: 136] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2005] [Revised: 07/28/2005] [Accepted: 08/16/2005] [Indexed: 11/27/2022]
Abstract
BACKGROUND Vocal cord paralysis is associated with extrathyroidal invasive malignancy. This study was performed to analyze the presentation of patients with invasive thyroid malignancy and to determine the preoperative symptomatic and radiographic correlates of vocal cord paralysis. METHODS In a group of 365 consecutive patients undergoing thyroidectomy, the group of 21 patients with invasive thyroid malignancy was compared with the 344 patients who had benign thyroid disease or noninvasive cancers. RESULTS Preoperative recurrent laryngeal nerve paralysis was a robust marker for invasive thyroid malignancy, being present in 70% of patients with invasive disease and only 0.3% of patients with noninvasive disease. Vocal cord paralysis was associated with voice change in only one third of patients. Preoperative computed tomography was read as positive for vocal cord paralysis in only 25% of patients. CONCLUSIONS Laryngoscopic examination is essential for the detection of vocal cord paralysis preoperatively. Symptomatic voice assessment and radiographic evaluation are insufficient. Preoperative vocal cord paralysis tracts with invasive disease and facilitates preoperative recognition of disease extent, allowing for appropriate operative planning and central neck clearance at first operation. Because of the prevalence (approximately 6% in our study) of invasive thyroid disease, the importance of preoperative diagnosis of invasive disease in operative planning and patient counseling, and the importance of vocal cord functional analysis in recurrent laryngeal nerve management algorithms for nerves found infiltrated at operation, and laryngoscopic examination is recommended for all patients undergoing thyroid operation.
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Affiliation(s)
- Gregory W Randolph
- Department of Otology and Laryngology, Harvard Medical School, Boston, MA, USA.
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McCaffrey JC. Aerodigestive Tract Invasion by Well-Differentiated Thyroid Carcinoma: Diagnosis, Management, Prognosis, and Biology. Laryngoscope 2006; 116:1-11. [PMID: 16481800 DOI: 10.1097/01.mlg.0000200428.26975.86] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS 1) To describe the clinical entity invasive well-differentiated thyroid carcinoma (IWDTC), 2) to determine prognostic factors for survival in patients with IWDTC, 3) to describe and compare types of surgical resection to determine treatment efficacy, 4) to offer a staging system and surgical algorithm for management of patients with IWDTC, 5) to examine alterations in expression of E-cadherin and beta-catenin adhesion molecules in three groups of thyroid tissue and propose a cellular mechanism for invasion of the aerodigestive tract. STUDY DESIGN Basic science: quantification of expression of E-cadherin and beta-catenin in three groups of thyroid tissue. Clinical: retrospective review of patients with IWDTC surgically treated and followed over a 45-year time period. METHODS Basic science: immunohistochemical staining was used with antibodies against E-cadherin and beta-catenin in three groups of tissue: group 1, normal control thyroid tissue (n = 10); group 2, conventional papillary thyroid carcinoma (n = 20); group 3, IWDTC (n = 12). Intensity scores were given on the basis of protocol. One-way analysis of variance (ANOVA) was used to evaluate differences between groups. Post hoc ANOVA testing was completed. P < .05 was significant. Clinical: patients were divided into three surgical groups within the laryngotracheal subset: group 1, complete resection of gross disease (n = 34); group 2, shave excision (n = 75); group 3, incomplete excision (n = 15). Cox regression analysis was used to determine significance of prognostic factors. Kaplan-Meier plots were used to evaluate survival. P < .05 was significant. RESULTS Basic science: a significant difference between the three thyroid tissue groups for E-cadherin expression was demonstrated on one-way ANOVA testing. When controls were compared with either experimental group in post hoc ANOVA testing, differences between all groups were demonstrated (P < .001). For beta-catenin, the intensities of the three groups were not different by one-way ANOVA testing. Similar nonsignificant results were found on post hoc ANOVA testing. Clinical: there was a statistically significant difference in survival for patients with and without involvement of any portion of the endolarynx or trachea (P < .01). There was a significant difference among all three surgical groups when compared (P < .001). When complete and shave groups were compared with gross residual group there was a significant decrease in survival in incomplete resection group (P < .01). Cox regression analysis demonstrated invasion of larynx and trachea were significant prognostic factors for poor outcome. The type of initial resection was significant on multivariate analysis. Removal of all gross disease is a major factor for survival. CONCLUSIONS Basic science: there is a decrease in membrane expression of E-cadherin in IWDTC, and loss of this tumor suppressor adhesion molecule may contribute to the invasive nature of well-differentiated thyroid carcinomas. Clinical: laryngotracheal invasion is a significant independent prognostic factor for survival. Patients undergoing shave excision had similar survival when compared with those undergoing radical tumor resection if gross tumor did not remain. Gross intraluminal tumor should be resected completely. Shave excision is adequate for minimal invasion not involving the intraluminal surfaces of the aerodigestive tract.
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Affiliation(s)
- Judith Czaja McCaffrey
- Department of Interdisciplinary Oncology, University of South Florida School of Medicine, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA.
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24
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Kim AW, Maxhimer JB, Quiros RM, Weber K, Prinz RA. Surgical management of well-differentiated thyroid cancer locally invasive to the respiratory tract. J Am Coll Surg 2005; 201:619-27. [PMID: 16183503 DOI: 10.1016/j.jamcollsurg.2005.05.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2005] [Accepted: 05/24/2005] [Indexed: 11/17/2022]
Affiliation(s)
- Anthony W Kim
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL 60612, USA
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25
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Zbären P, Nuyens M, Thoeny HC, Stauffer E. Laryngeal involvement by differentiated thyroid carcinoma. Am J Surg 2005; 190:153-5. [PMID: 15972190 DOI: 10.1016/j.amjsurg.2005.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2004] [Revised: 12/31/2004] [Indexed: 11/26/2022]
Abstract
BACKGROUND Invasion of the larynx by differentiated thyroid gland carcinoma is uncommon but causes serious morbidity and mortality when present. METHODS The clinicopathologic characteristics of 5 patients in which a total laryngectomy had to be performed for differentiated thyroid carcinoma are analyzed. Special reference is paid to the histologic intralaryngeal tumor spread, which is evaluated on whole-organ section. RESULTS All patients presented with hoarseness and/or dyspnea. Two patients are alive at 44 and 115 months. One patient died of intercurrent disease 2 months and 2 patients with disease 6 and 14 months after surgery. In all cases, intralaryngeal tumor spread was observed. Invasion of the larynx occurs by direct extension or by posterior tumor growth around the edge of the thyroid cartilage. CONCLUSION In rare cases, differentiated thyroid carcinoma can widely infiltrate the larynx, making total laryngectomy unavoidable. The diagnosis of intralaryngeal tumor spread is done by imaging and endoscopy.
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Affiliation(s)
- Peter Zbären
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, CH-3000 Bern, Switzerland.
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26
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize existing literature with respect to locally advanced thyroid cancer and define the intricacies of preoperative evaluation, surgical management of involved sites and postoperative treatment. RECENT FINDINGS Locally invasive thyroid cancer is an uncommon disease process, which carries significant morbidity and mortality. Current treatment modalities include appropriate surgery, radioactive iodine treatment and external beam radiation therapy. Proper evaluation of the extent of disease, with complete gross tumor removal, is paramount in managing this difficult problem. Surgical treatment is still the mainstay for locally advanced thyroid cancer. SUMMARY Little progress has been made in advancing the treatment of locally advanced thyroid cancer. Patient identification, evaluation and proper surgical management with adjuvant therapy, still remain the most effective course of treatment. Aggressive surgical treatment including removal of all gross tumor and still preserving vital structures along with adjuvant therapy is likely to offer the best results. There is a very high incidence of locoregional and distant failure in this group of patients. The understanding and recognition of histopathological variations, such as poorly differentiated thyroid cancer is also important. New molecular markers are needed to help identify and predict aggressive tumor behavior.
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Affiliation(s)
- Kepal N Patel
- Head and Neck Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY 10021, USA
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27
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Abstract
The management of locally advanced thyroid carcinoma can be challenging. Differing philosophies exist for the treatment of invasive disease affecting the upper aerodigestive tract. The ability to maximize local control and overall survival while minimizing the morbidity of a radical resection is the goal of care in these patients. This article will review the literature concerning the presentation, preoperative evaluation, and the subsite treatment of locally aggressive well-differentiated thyroid carcinoma.
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Affiliation(s)
- Richard O Wein
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, USA.
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28
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Chang HS. Treatment of Locally Advanced Thyroid Cancer. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2004. [DOI: 10.5124/jkma.2004.47.12.1168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Hang-Seok Chang
- Department of Surgery, Yonsei University College of Medicine, Yongdong Severance Hospital, Korea.
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29
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Abstract
Although most patients with differentiated thyroid cancer (DTC) of follicular cell origin enjoy a relatively good prognosis, some patients unfortunately present with or develop locally advanced DTC which leads to significant local morbidity and mortality. DTC accounts for 54-94% of all locally advanced thyroid cancers. DTC invasion of the recurrent laryngeal nerve, strap muscles and trachea are the most common followed by invasion of the esophagus, internal jugular vein and carotid artery. Surgical resection is the primary treatment for locally advanced DTC. Although the optimal surgical approach (ranging from conservative shave excision to aggressive en bloc resection of tumor and vital structures) in patients with locally advanced DTC is controversial, a curative resection should be the goal unless complete tumor resection results in unwanted perioperative morbidity and mortality or widely metastatic disease is present. Postoperative radioiodine ablation with TSH suppression is imperative after surgical resection of locally advanced DTC. Patients with microscopic or small gross residual disease, after surgical resection, may benefit from postoperative external radiotherapy for local control of disease.
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Affiliation(s)
- Electron Kebebew
- Department of Surgery, University of California, San Francisco, UCSF/Mount Zion Medical Center, 513 Parnassus, S-343, San Francisco, CA 94143-1674, USA.
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30
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Wang J, Takashima S, Matsushita T, Takayama F, Kobayashi T, Kadoya M. Esophageal invasion by thyroid carcinomas: prediction using magnetic resonance imaging. J Comput Assist Tomogr 2003; 27:18-25. [PMID: 12544237 DOI: 10.1097/00004728-200301000-00004] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE We evaluated the accuracy of magnetic resonance imaging (MRI) in predicting esophageal invasion by thyroid carcinomas and established an optimal criterion for diagnosing esophageal invasion. METHOD The MRI findings (size and margins of tumor, ratio of tumor contact to the esophagus, shape and displacement of the esophagus, and tumor invasion to the outer and inner layers of the esophagus) in 67 patients with thyroid carcinomas were retrospectively reviewed and correlated with surgical and pathologic findings. Logistic modeling was used to determine the significant factors for predicting esophageal invasion. RESULTS Seventeen (34%) of the 67 patients had pathologically or surgically verified esophageal invasion. The logistic modeling revealed that outer layer invasion (P < 0.001) and poorly defined margins (P = 0.001) were the significant factors. The outer layer invasion showed the highest accuracy of 91%, with 82% sensitivity and 94% specificity. The addition of poorly defined margins to this criterion did not improve its accuracy. CONCLUSION Esophageal invasion by thyroid carcinoma was accurately predicted with MRI, and an MRI finding of outer layer invasion was optimal for diagnosing esophageal invasion.
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Affiliation(s)
- Jichen Wang
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
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31
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Omura K, Kanehira E, Kawakami K, Maeda K, Ishiguro K, Ishikawa N, Ohta K, Watanabe G. Pharyngolaryngoesophagectomy for well-differentiated papillary thyroid carcinoma widely invading the upper aerodigestive tract. Surgery 2002; 132:885-8. [PMID: 12464874 DOI: 10.1067/msy.2002.126512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Kenji Omura
- Department of General and Cardiothoracic Surgery, Kanazawa University Faculty of Medicine School of Medicine, Kanazawa, Japan
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Abstract
BACKGROUND Well-differentiated thyroid carcinoma usually has an excellent prognosis. However, when extrathyroidal invasion occurs, it is associated with significant morbidity and mortality. This report presents the experience of a single institution in the treatment of patients with locally invasive, well-differentiated thyroid carcinoma. PATIENTS AND METHODS Forty-six patients with locally invasive well-differentiated thyroid carcinoma were diagnosed. Histopathologic types included: 28 papillary carcinoma and 18 follicular. RESULTS Patients with exclusive invasion of the muscle or recurrent laryngeal nerve usually had complete tumor resection. Patients with tracheal, laryngeal, or esophageal invasion usually underwent shave resection. The factors that adversely affected survival were: age >45 years, preoperative diagnosis of extrathyroidal extension, and incomplete resection (p <.05). CONCLUSIONS There were similar survival results after complete or shave resection and poor survival when the resection was incomplete. Tumors with minimal invasion can be treated by shave resection with acceptable survival and low morbidity.
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Affiliation(s)
- Luiz Paulo Kowalski
- Head and Neck Surgery and Otorhinolaryngology Department, Centro de Tratamento e Pesquisa Hospital do Câncer A. C. Camargo, Fundação Antonio Prudente, Rua Professor Antonio Prudente, 211, São Paulo, Brazil CEP 01509-010.
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34
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Weigel RJ. Thyroid. Surgery 2001. [DOI: 10.1007/978-3-642-57282-1_39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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35
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Yoshidumi T, Ebihara M, Satake B, Hirao T, Ohshiro T, Ebihara S, Hayashi R, Saikawa M, Ohyama W. Long Term Results of Treatment for Locally Advanced Thyroid Cancer. ACTA ACUST UNITED AC 2001. [DOI: 10.2468/jbes.52.137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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36
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Nishida T, Nakao K, Hashimoto T. Local control in differentiated thyroid carcinoma with extrathyroidal invasion. Am J Surg 2000; 179:86-91. [PMID: 10773139 DOI: 10.1016/s0002-9610(00)00275-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The clinical significance of microscopically locoresional-residual differentiated thyroid carcinoma is still an unsolved problem. METHODS Patients who underwent resectional management for advanced differentiated thyroid carcinoma were divided into complete (n = 58), microscopic (n = 37), macroscopic (n = 14), and distant (n = 22) groups. RESULTS Postoperative recurrence was similar in the complete (28%) and microscopic (22%) groups and was significantly lower than that of the macroscopic (57%) and distant (67%) groups. Age, gender, lymph node metastasis, and the residual status (complete and microscopic versus macroscopic and distant) were independent risk factors for recurrence. Postoperative survival of the complete and microscopic groups groups was better than that of the macroscopic and distant groups. Age and the residual status were independent prognostic factors for overall and cause-specific survival. CONCLUSIONS Postoperative recurrence and survival of patients with microscopic residual cancer were similar to those of patients with complete resection, and macroscopic residual cancer either in locoregional or distant loci was an ominous prognostic sign.
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MESH Headings
- Adenocarcinoma, Follicular/classification
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/secondary
- Adenocarcinoma, Follicular/surgery
- Age Factors
- Analysis of Variance
- Carcinoma/classification
- Carcinoma/pathology
- Carcinoma/secondary
- Carcinoma/surgery
- Carcinoma, Papillary/classification
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/secondary
- Carcinoma, Papillary/surgery
- Female
- Follow-Up Studies
- Humans
- Linear Models
- Lymphatic Metastasis/pathology
- Male
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/prevention & control
- Neoplasm, Residual
- Prognosis
- Proportional Hazards Models
- Retrospective Studies
- Risk Factors
- Sex Factors
- Survival Rate
- Thyroid Neoplasms/classification
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/surgery
- Thyroidectomy/methods
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Affiliation(s)
- T Nishida
- Department of Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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37
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Gillenwater AM, Goepfert H. Surgical management of laryngotracheal and esophageal involvement by locally advanced thyroid cancer. SEMINARS IN SURGICAL ONCOLOGY 1999; 16:19-29. [PMID: 9890736 DOI: 10.1002/(sici)1098-2388(199901/02)16:1<19::aid-ssu5>3.0.co;2-w] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Well-differentiated thyroid cancer usually progresses slowly and rarely invades other tissues. However, the rare cases with invasion of local structures, such as the larynx, trachea, or esophagus, present particular management difficulties. In situations with limited involvement of the larynx or trachea, there is controversy over whether a "shave excision" that may leave microscopic disease at the site, or a complete resection that includes removal of a portion of these structures is the better approach. In the case of more extensive involvement of upper aerodigestive tract structures by thyroid carcinomas, the most appropriate method of resection and reconstruction is also at issue. We discuss the literature pertaining to the surgical management of laryngotracheal and esophageal invasion by thyroid carcinoma, review the incidence and presentation of this disease, and make recommendations based on our own experience.
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Affiliation(s)
- A M Gillenwater
- Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
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38
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Edney JA. 50 years of breast, endocrine, and oncologic surgery at the Southwestern Surgical Congress: earlier diagnosis and improved outcomes. Am J Surg 1998; 175:92S-98S. [PMID: 9558057 DOI: 10.1016/s0002-9610(98)00065-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J A Edney
- Department of Surgery, University of Nebraska Medical Center, Omaha 68198-3280, USA
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39
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Nishida T, Nakao K, Hamaji M, Kamiike W, Kurozumi K, Matsuda H. Preservation of recurrent laryngeal nerve invaded by differentiated thyroid cancer. Ann Surg 1997; 226:85-91. [PMID: 9242342 PMCID: PMC1190911 DOI: 10.1097/00000658-199707000-00012] [Citation(s) in RCA: 75] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE This study was undertaken to determine whether the recurrent laryngeal nerve involved in differentiated thyroid carcinoma could be preserved. SUMMARY BACKGROUND DATA Few investigations have provided definitive results concerning preservation of the recurrent laryngeal nerve involved in thyroid cancer. Complete excision with resection of the recurrent laryngeal nerve reportedly did not improve survival over incomplete excision in differentiated thyroid carcinoma. METHODS A retrospective study was performed with the medical records of 50 patients with differentiated carcinoma and preoperative normal vocal cord function to investigate outcomes of recurrent laryngeal nerve preservation including local recurrence, prognosis, and postoperative vocal cord function. The recurrent laryngeal nerves on 1 or both sides were preserved in 23 patients (the preserved group), whereas the involved recurrent laryngeal nerve of the other 27 patients was resected (the resected group). RESULTS Backgrounds of patients were similar between the resected and preserved groups. The number of patients with recurrences in each group was similar, and incidence of local, regional, and distant metastatic recurrences were not different between the groups. Postoperative overall survival of the preserved group was similar to that of the resected group (p = 0.1208). More than 60% of patients or of nerve at risk in the preserved group restored normal vocal cord function within 6 months. Some functional vocal cord movement was recognized in 80% of patients or of nerve at risk. All patients in the resected group including patients with nerve anastomosis showed permanent paralysis of the ipsilateral vocal cord. CONCLUSIONS These results suggested that the recurrent laryngeal nerve, even if infiltrated by differentiated thyroid cancer, is worthwhile to preserve for maintenance of postoperative vocal cord function without affecting the incidence of local recurrence or prognosis.
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Affiliation(s)
- T Nishida
- First Department of Surgery, Osaka University Medical School, Suita, Japan
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Nishida T, Nakao K, Hamaji M. Differentiated thyroid carcinoma with airway invasion: indication for tracheal resection based on the extent of cancer invasion. J Thorac Cardiovasc Surg 1997; 114:84-92. [PMID: 9240297 DOI: 10.1016/s0022-5223(97)70120-x] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Although aggressive approaches to locally invasive differentiated thyroid carcinoma are reported to improve the prognosis, few investigations have provided an indication for airway resection. The present study was undertaken to determine the best indication for airway resection for differentiated thyroid carcinoma invading the trachea. METHODS One hundred seventeen patients with differentiated thyroid carcinoma invading surrounding structures were retrospectively studied for local failures and prognosis and were divided into five groups mainly on the basis of macroscopic findings: Group 1 consisted of 40 patients who underwent tracheal resection for deep tracheal invasion; group 2 consisted of 14 patients with deep tracheal invasion and no airway resection; group 3 consisted of 13 patients with superficial tracheal invasion and no airway resection; group 4 comprised 48 patients with extrathyroidal invasion other than laryngotracheal structures; and group 5 consisted of two patients who underwent tracheal resection for superficial invasion. RESULTS Resectional management of the airway for patients with deep tracheal invasion decreased local recurrence and improved postoperative prognosis compared with nonresectional management for the tumor, or shaving off tumor from the trachea for patients with superficial invasion, did not increase postoperative local failures or mortality (group 3 vs groups 4, 5, and 1). CONCLUSION These results implied that differentiated thyroid carcinomas with superficially limited invasion could be treated successfully by nonresectional management of the trachea and that those with deep invasion should be treated by resection of the invaded trachea.
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Affiliation(s)
- T Nishida
- First Department of Surgery, Osaka University Medical School, Japan
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Affiliation(s)
- S K Grebe
- Division of Endocrinology and Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Vassilopoulou-Sellin R, Schultz PN, Haynie TP. Clinical outcome of patients with papillary thyroid carcinoma who have recurrence after initial radioactive iodine therapy. Cancer 1996; 78:493-501. [PMID: 8697396 DOI: 10.1002/(sici)1097-0142(19960801)78:3<493::aid-cncr17>3.0.co;2-u] [Citation(s) in RCA: 71] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Among patients with well differentiated papillary thyroid carcinoma who generally have an excellent prognosis and a near-normal lifespan, there exist subsets of patients who have significant risk for morbidity and mortality from this disease. It is important to define the patterns of disease progression and the clinical outcome of such patients to develop effective surveillance and treatment strategies. Patients with recurrence after surgery and therapeutic administration of radioactive iodine (RAI) for papillary thyroid carcinoma represent one such subset of high-risk patients. METHODS At the University of Texas M. D. Anderson Cancer Center, 65 patients with papillary thyroid carcinoma were diagnosed between 1970 and 1990. Their medical records were reviewed with particular attention to disease recurrence and outcome as well as RAI imaging and treatment. RESULTS Following diagnosis and initial therapy, 19 patients died from thyroid carcinoma after a median of 64 months; 34 had no evidence of disease for a median of 112 months of available follow-up; and 7 are alive with disease 61 to 153 months after diagnosis. Cervical lymph node metastases were present in 41 patients and extrathyroidal or extranodal tumor invasion was seen in 25 patients at the time of initial surgery; distant metastases (lung, bone, brain, liver, and adrenal) developed later in 18 patients. RAI uptake by recurrent tumor deposits in the neck was seen most frequently in patients with no direct invasion of adjacent tissues but with recurrence limited to cervical lymphadenopathy; this group of patients was the most likely to become clinically and radiologically disease free. RAI generally did not concertrate in invasive cancers with extrathyroidal or extranodal extension in the neck; patients with this type of invasive carcinoma were also more likely to die from the disease. CONCLUSIONS We suggest that among patients with recurrent papillary thyroid carcinoma, invasive cancers are less likely to concertrate RAI, whereas patients with disease confined to lymph nodes are more likely to have RAI-avid tumors and to benefit from RAI therapy.
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Affiliation(s)
- R Vassilopoulou-Sellin
- Section of Endocrinology, Division of Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA
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