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Raffaelli M, Voloudakis N, Barczynski M, Brauckhoff K, Durante C, Gomez-Ramirez J, Koutelidakis I, Lorenz K, Makay O, Materazzi G, Pandev R, Randolph GW, Tolley N, Vriens M, Musholt T. European Society of Endocrine Surgeons (ESES) consensus statement on advanced thyroid cancer: definitions and management. Br J Surg 2024; 111:znae199. [PMID: 39158073 PMCID: PMC11331340 DOI: 10.1093/bjs/znae199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/16/2024] [Accepted: 07/15/2024] [Indexed: 08/20/2024]
Affiliation(s)
- Marco Raffaelli
- UOC Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità (CREO), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nikolaos Voloudakis
- UOC Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Marcin Barczynski
- Department of Endocrine Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Katrin Brauckhoff
- Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Joaquin Gomez-Ramirez
- Endocrine Surgery Unit, General Surgery Department, Hospital Universitario La Paz, IdiPaz Madrid, Madrid, Spain
| | - Ioannis Koutelidakis
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ozer Makay
- Centre for Endocrine Surgery, Ozel Saglik Hospital, Izmir, Turkey
| | - Gabriele Materazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Rumen Pandev
- Department of General Surgery, University Hospital St Marina, Medical University Pleven, Pleven, Bulgaria
| | - Gregory W Randolph
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Neil Tolley
- Endocrine Surgery Service, Imperial College NHS Healthcare Trust, London, UK
| | - Menno Vriens
- Department of Surgical Oncology and Endocrine Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Thomas Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medicine Mainz, Mainz, Germany
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Farlow JL, McCrary HC, Sipos JA, Phay JE, Konda B, Agrawal A. Neoadjuvant dabrafenib and trametinib for functional organ preservation in recurrent BRAF V600E-mutated papillary thyroid cancer. Oral Oncol 2023; 147:106625. [PMID: 37948895 DOI: 10.1016/j.oraloncology.2023.106625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES To describe the first reported use of neoadjuvant dabrafenib and trametinib specifically to permit organ conservation surgery in locally advanced recurrent differentiated thyroid carcinoma. PATIENTS AND METHODS A patient presented with locally recurrent, radioiodide-resistant DTC with a BRAF V600E mutation invading the laryngotrachea. Definitive treatment would require a total laryngectomy. She was offered neoadjuvant dabrafenib and trametinib prior to surgery. RESULTS A significant radiographic response permitted partial laryngectomy, enabling preservation of voice, early resumption of oral feeding, and avoidance of permanent tracheostomy. At 9 months, she remained free of disease. CONCLUSION Neoadjuvant tyrosine kinase inhibitor treatment prior to definitive surgery for locally-invasive recurrent DTC is a potential approach that may limit the degree of surgery and associated morbidity.
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Affiliation(s)
- Janice L Farlow
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Otolaryngology-Head and Neck Surgery, Indiana University, Indianapolis, IN, USA
| | - Hilary C McCrary
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Department of Otolaryngology-Head and Neck Surgery, University of Utah, Salt Lake City, UT, USA
| | - Jennifer A Sipos
- Division of Endocrinology, Diabetes, and Metabolism, Department of Internal Medicine, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - John E Phay
- Division of Surgical Oncology, Department of Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Bhavana Konda
- Division of Medical Oncology, Department of Internal Medicine, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Amit Agrawal
- Department of Otolaryngology-Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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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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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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7
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Tiwari Y, Krishnamurthy A. Long-term outcomes of differentiated thyroid cancers with tracheal invasion: A 15-year experience. Indian J Cancer 2020; 57:398-404. [PMID: 32675437 DOI: 10.4103/ijc.ijc_456_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Tracheal invasion is reported to occur in approximately one-third of the patients of locally advanced thyroid cancers. There is a paucity of data in literature with regard to the long-term outcomes of thyroid cancers with tracheal invasion. METHODS A total of 37 patients from our tertiary care center underwent radical surgery for tracheal involvement for differentiated thyroid cancers between the years 2002 and 2016. The variables pertaining to the demographics, clinical presentation, imaging, operative details and histopathology reports were captured from the patient's case records and analyzed. RESULTS Among the 37 patients, there were 21 males and 16 females. Majority of the patients (56.8%) were >55 years of age. Surgery (tracheal resection) was performed in the primary setting in 29 patients, whereas it was performed in a recurrent setting in 8 patients. As per the Shin classification, 3 patients belonged to Shin stage 1, 3 to Shin stage 2, 16 patients to Shin stage 3 and 15 patients to Shin stage 4. There was no 30 day postoperative mortality in our cohort. The median follow-up of our cohort was 175 months. The 5-, 10-, and the 15-year overall survivals of the entire cohort were 81.7%, 47.8%, and 35.9%, respectively. CONCLUSION Our series shows favorable long-term oncological outcomes of selected patients of thyroid cancers with tracheal resection and adds to the limited long-term data available in literature.
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Affiliation(s)
- Yogesh Tiwari
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
| | - Arvind Krishnamurthy
- Department of Surgical Oncology, Cancer Institute (WIA), Chennai, Tamil Nadu, India
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Allen M, Spillinger A, Arianpour K, Johnson J, Johnson AP, Folbe AJ, Hotaling J, Svider PF. Tracheal Resection in the Management of Thyroid Cancer: An Evidence-Based Approach. Laryngoscope 2020; 131:932-946. [PMID: 32985692 DOI: 10.1002/lary.29112] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/28/2020] [Accepted: 09/04/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Determine the effect of patient demographics and surgical approach on patient outcomes after tracheal resection in the management of thyroid cancer. STUDY DESIGN Systematic review and meta-analysis. METHODS Systematic review of literature was performed using PubMed, Embase, and Cochrane Library to identify patients with thyroid carcinoma who underwent tracheal resection. Pooled estimates for patient demographics, presenting findings, complications, and outcomes are determined using random-effects meta-analyses. RESULTS Ninety-six relevant studies encompassing 1,179 patients met inclusion criteria. Meta-analysis pooled rates of complications: 1.7% (confidence interval [CI] 0.8-2.5; P < .001; I2 = 1.85%) airway complications, 2.8% (CI 1.6-3.9; P < .001; I2 = 13.34%) bilateral recurrent laryngeal nerve paralysis, 2.2% (CI 1.2-3.1; P < .001; I2 = 6.72%) anastomotic dehiscence. Circumferential resection pooled estimates major complications, locoregional recurrence, distal recurrence, overall survival: 14.1% (CI 8.3-19.9; P < .001; I2 = 35.26%), 15% (CI 9.6-20.3; P < .001; I2 = 38.2%), 19.7% (CI 13.7-25.8; P < .001; I2 = 28.83%), 74.5% (CI 64.4-84.6; P < .001; I2 = 85.07%). Window resection estimates: 19.8% (CI 6.9-32.8; P < .001; I2 = 18.83%) major complications, 25.6% (CI 5.1-46.1; P < .014; I2 = 84.68%) locoregional recurrence, 15.6% (CI 9.7-21.5; P < .001; I2 = 0%) distal recurrence, 77.1% (CI 58-96.2; P < .001; I2 = 78.77%) overall survival. CONCLUSION Management of invasive thyroid carcinoma may require tracheal resection to achieve locoregional control. Nevertheless, postoperative complications are not insignificant, and therefore this risk cannot be overlooked when counseling patients perioperatively. Laryngoscope, 131:932-946, 2021.
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Affiliation(s)
- Meredith Allen
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A
| | - Aviv Spillinger
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A
| | | | - Jared Johnson
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Andrew P Johnson
- Department of Otolaryngology-Head and Neck Surgery, University of Colorado Medical School, Aurora, Colorado, U.S.A
| | - Adam J Folbe
- Oakland University William Beaumont School of Medicine, Rochester, Michigan, U.S.A
| | - Jeffrey Hotaling
- Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan, U.S.A.,Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Peter F Svider
- Hackensack Meridian Health, Hackensack University Medical Center, Hackensack, New Jersey, U.S.A
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Gupta V, Rao C, Raju KVVN, Nemade H, Dasu S, Jayakarthik Y, Shukla S, Rao TS. Tracheal/Laryngeal Infiltration in Thyroid Cancer: a Single-Centre Experience. Indian J Surg Oncol 2019; 11:75-79. [PMID: 32205975 DOI: 10.1007/s13193-019-00994-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/25/2019] [Indexed: 02/07/2023] Open
Abstract
Around 1/3 of patients of locally advanced carcinoma thyroid present with tracheal infiltration either alone or along with infiltration of other adjacent structures. Even though trachea is infiltrated, adequate resection is the main modality of treatment in these patients. We retrospectively analysed carcinoma thyroid patients who were operated at our institute, between January 2011 and December 2018, and underwent thyroidectomy with tracheal or laryngeal resection. Seventeen patients underwent tracheal/laryngeal resection with thyroidectomy. The mean age of patients was 57 years. Six and eleven were male and female, respectively, 0.14 (82%) patients had dyspnoea on presentation, 6 had hoarseness of voice, 6 had haemoptysis, and in 2 patients, neck swelling was the only complain. Two patients in our study presented with acute stridor, underwent emergency intubation and subsequently surgery. Two other patients had bulky pedunculated tumour in preoperative bronchoscopy and required tracheostomy for intubation before proceeding with surgery. In 11 patients, sleeve resection followed by end-to-end anastomosis was done, window resection was done in 3 patients, partial laryngectomy in 1, and total laryngectomy in 2 patients. In 10 patients (59%), the site of infiltration was in the lateral tracheal wall, with relatively small posterior primary (mean size 3.7 cm) in the thyroid lobe. Two patients developed postoperative complication, one patient with sleeve resection had secondary haemorrhage, and one patient who underwent window resection with myochondrial thyroid lamina flap reconstruction developed salivary fistula. These patients underwent re exploration with tracheostomy and were subsequently decannulated. Preoperative diagnosis of tracheal infiltration helps in better planning of surgery and counseling the patients of any possible complication. Clinical workup and pre-emptive diagnosis is therefore of paramount importance.
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Affiliation(s)
- Vikas Gupta
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - Chandrashekhar Rao
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - K V V N Raju
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - Hemantkumar Nemade
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - Sridhar Dasu
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - Y Jayakarthik
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - Srijan Shukla
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
| | - T Subramanyeshwar Rao
- Department of Surgical Oncology, Basavatarakam Indo American Cancer Hospital & Research Institute, Hyderabad, India
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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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Appropriateness of Subadventitial Resection for Invasion of the Carotid Artery by Papillary Thyroid Carcinoma. World J Surg 2018; 43:519-526. [PMID: 30225564 DOI: 10.1007/s00268-018-4787-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Selection of surgical treatment for patients with papillary thyroid carcinoma (PTC) that includes great vessel invasion is challenging. We investigated the efficacy of tumor excision, with regard to safety of the surgical procedure and prognosis among patients with PTC invasion of the carotid or vertebral artery. METHODS This study is a retrospective review of patients who underwent surgical excision for PTC at our institution, between 1981 and 2010, with 49 patients treated for carotid artery invasion and nine for vertebral artery invasion. RESULTS Twenty patients with carotid artery invasion receiving initial treatment underwent subadventitial resection. Among 29 relapsing patients with carotid artery invasion, subadventitial resection was performed in 27 and en-block resection and reconstruction in the other two. In patients with carotid artery invasion, locoregional recurrence was identified in 14 patients, with the recurrence specific to the carotid artery in one case and distant recurrence in 15. The 10-year disease-specific survival rate was shorter among relapsing patients (21.7%) than among those receiving an initial treatment (69.3%). At 8 years after surgery, however, the survival rates were comparable between the two groups. Of the nine patients with vertebral artery invasion, two received initial treatment, with either preservation or reconstruction of the vertebral artery. The other six cases were tumor recurrences, treated by tumor and vertebral artery resection. Vertebral artery invasion was associated with carotid artery invasion in five patients and subclavian artery invasion in four. CONCLUSIONS Carotid artery invasion by PTC did not extend beyond the adventitia of the artery in the majority of patients. Most patients with vertebral artery invasion required tumor excision with vertebral artery resection.
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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: 22] [Impact Index Per Article: 3.7] [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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Abstract
BACKGROUND Papillary thyroid carcinoma (PTC) has an excellent prognosis. Although rare, PTC invasion into the upper aerodigestive tract can adversely affect patient prognosis and quality of life. This study investigated the impact of tumor excision on the prognosis and postoperative status of patients with PTC invasion of the larynx. METHODS Data on PTC patients who underwent surgery at the author's institution between April 1981 and March 2010 were retrospectively reviewed, and 55 patients with thyroid cartilage invasion were enrolled. Curative resection was performed for all patients, and laryngeal function was preserved or reconstructed when possible. RESULTS Of the 55 patients, 40 and 15 patients had superficial and intraluminal invasion of the larynx, respectively. The 10-year disease-specific survival rates were 81.0% and 61.4% in patients who underwent surgery for superficial and intraluminal invasion of the larynx, respectively. Only two patients (3.6%) had an isolated locoregional recurrence in the larynx. Four patients (7.3%) underwent total laryngectomy during the initial surgery or surgery for laryngeal recurrence. Permanent stoma remained in 26 patients (47%): 14 with laryngeal invasion, and 12 with invasion of other aerodigestive structures. The number of invaded aerodigestive structures including the larynx was correlated with the presence of permanent stoma. CONCLUSIONS In many patients, PTC invasion of the larynx remained at the thyroid cartilage or paraglottic space. Most patients did not require total laryngectomy. Good locoregional control was achieved with surgical tumor excision in patients with laryngeal invasion. Distant metastases were the major cause of death in patients with PTC invasion of the larynx.
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Affiliation(s)
- Sueyoshi Moritani
- Center for Head and Neck Surgery, Kusatsu General Hospital , Kusatsu, Japan
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Shindo ML, Caruana SM, Kandil E, McCaffrey JC, Orloff LA, Porterfield JR, Shaha A, Shin J, Terris D, Randolph G. Management of invasive well-differentiated thyroid cancer: an American Head and Neck Society consensus statement. AHNS consensus statement. Head Neck 2014; 36:1379-90. [PMID: 24470171 DOI: 10.1002/hed.23619] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2013] [Accepted: 01/24/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Invasive differentiated thyroid cancer (DTC) is relatively frequent, yet there is a paucity of specific guidelines devoted to its management. The Endocrine Committee of the American Head and Neck Society (AHNS) convened a panel to provide clinical consensus statements based on review of the literature, synthesized with the expert opinion of the group. METHODS An expert panel, selected from membership of the AHNS, constructed the manuscript and recommendations for management of DTC with invasion of recurrent laryngeal nerve, trachea, esophagus, larynx, and major vessels based on current best evidence. A Modified Delphi survey was then constructed by another expert panelist utilizing 9 anchor points, 1 = strongly disagree to 9 = strongly agree. Results of the survey were utilized to determine which statements achieved consensus, near-consensus, or non-consensus. RESULTS After endorsement by the AHNS Endocrine Committee and Quality of Care Committee, it received final approval from the AHNS Council.
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Affiliation(s)
- Maisie L Shindo
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon
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Bronchoscopic interventions combined with percutaneous modalities for the treatment of thyroid cancers with airway invasion. Eur Arch Otorhinolaryngol 2014; 272:445-51. [DOI: 10.1007/s00405-014-2963-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 02/18/2014] [Indexed: 12/19/2022]
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Morisod B, Monnier P, Simon C, Sandu K. Cricotracheal resection for laryngeal invasion by thyroid carcinoma: our experience. Eur Arch Otorhinolaryngol 2013; 271:2261-6. [DOI: 10.1007/s00405-013-2757-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 10/02/2013] [Indexed: 10/26/2022]
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Abstract
About 6% of patients with thyroid cancer present with life-threatening tumor invasion of the trachea and/or esophagus. The extent of resection depends on tumor diagnosis and stage (indication only in differentiated and perhaps medullary thyroid cancer without extrapulmonary metastases), extent of aerodigestive invasion, and general health state of the patient. After complete tumor resection, 5-year and 10-year survival rates of 40-75% can be achieved. Incomplete tumor resection however has a negative effect on prognosis. Tangential tumor resection (shaving) is indicated if no transmural invasion of trachea/esophagus has occurred. Tracheal resection can be subdivided into six standard procedures--types 1 and 2: laryngotracheal or tracheal window resection; types 3 and 4: circular resection with primary reconstruction infraglottic or tracheal; and types 5 and 6: laryngectomy and cervical evisceration.
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Affiliation(s)
- M Brauckhoff
- Department of Surgery, Haukeland University Hospital, University of Bergen, Jonas Lies vei 65, Bergen, Norway.
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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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Tsutsui H, Usuda J, Kubota M, Yamada M, Suzuki A, Shibuya H, Miyajima K, Tanaka K, Sugino K, Ito K, Kato H. Endoscopic tumor ablation for laryngotracheal intraluminal invasion secondary to advanced thyroid cancer. Acta Otolaryngol 2008; 128:799-807. [PMID: 18568524 DOI: 10.1080/00016480701714285] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
CONCLUSIONS Endoscopic tumor ablation is a valuable option for inoperable postoperative laryngotracheal intraluminal invasion of well-differentiated thyroid carcinoma (DTC). OBJECTIVES To investigate whether DTC invasion to the laryngotracheal mucosa can be controlled by 'simple' tumor ablation considering its relatively slow-growing nature. PATIENTS AND METHODS Twenty-two consecutive patients underwent endoscopic tumor ablation caused by DTC for local control of intraluminal lesions with no significant extrinsic laryngotracheal compression in symptomatic or asymptomatic patients in whom radical operations were contraindicated. Debulking by Nd:YAG laser was followed by electrocoagulation and microwave coagulation for the residual tumor base. RESULTS The critical complication, post-treatment supraglottic stenosis, was managed by prophylactic minitracheotomy. During the follow-up period of up to 125 months, 6 of 22 patients died (median survival 50 months), mainly of lung metastases, but all had a patent airway at death. Post-surgical extraluminal lesion growth is indolent and since relapse of the intraluminal lesion is the main cause of symptoms, satisfactory local control could be obtained by re-ablation of the mucosal lesion every few years. Lesions requiring retreatment within 1 year after initial treatment usually have high-grade malignancy, causing extrinsic compression, and prognosis is unfavorable.
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Gaissert HA, Honings J, Grillo HC, Donahue DM, Wain JC, Wright CD, Mathisen DJ. Segmental Laryngotracheal and Tracheal Resection for Invasive Thyroid Carcinoma. Ann Thorac Surg 2007; 83:1952-9. [PMID: 17532377 DOI: 10.1016/j.athoracsur.2007.01.056] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Revised: 01/23/2007] [Accepted: 01/29/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Laryngotracheal invasion worsens prognosis in patients with thyroid carcinoma. The extent of resection is controversial. METHODS We performed a retrospective study of patients with thyroid carcinoma and invasion of the larynx or trachea between 1964 and 2005. RESULTS Eighty-two patients, mean age 64 years and 50% female, underwent segmental airway resection. Differentiated carcinoma was present in 76% (62 of 82 patients), prior tracheal "shave" procedures in 40% (33 of 82 patients), transmural invasion in 58% (48 of 82 patients), and preoperative vocal cord paralysis in 35% (29 of 82 patients). There were 29 tracheal and 40 laryngotracheal resections (reconstruction group: 69 patients); 5 underwent laryngectomy, 7 cervical exenteration, and 1 tracheal resection after exenteration (salvage group: 13 patients). Operative mortality was 1.2% (1 of 82 patients) and anastomotic dehiscence 4.3% (3 of 69 patients). Tracheostomy was permanent in 4.3% (3 of 69 patients). Mean follow-up was 6.1 years. After reconstruction, mean survival was 9.4 years and 10-year survival was 40%; after salvage, these were 5.6 years and 15%, respectively. In differentiated carcinoma, thyroidectomy, immediate shave procedure, and delayed (mean, 67 months) resection of airway recurrence in 15 patients resulted in overall and disease-free survival of 13.1 and 5.1 years, respectively, compared with 17.9 and 14.6 years, respectively, after thyroidectomy and early airway resection in 11 patients. Airway symptoms, metastases at presentation, recurrent disease, and salvage operation were associated with decreased survival; airway resection early after thyroidectomy, complete resection, and well-differentiated tumors were associated with improved prognosis. CONCLUSIONS Segmental airway resection for invasive thyroid cancer is safe, preserves the voice, and relieves airway obstruction. Complete resection of laryngeal and tracheal invasion during or early after thyroidectomy is associated with improved survival.
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Affiliation(s)
- Henning A Gaissert
- Division of Thoracic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, 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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Tsai YF, Tseng YL, Wu MH, Hung CJ, Lai WW, Lin MY. Aggressive resection of the airway invaded by thyroid carcinoma. Br J Surg 2005; 92:1382-7. [PMID: 16044411 DOI: 10.1002/bjs.5124] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to investigate the hypothesis that outcome following concomitant airway resection is superior to that after shaving of the tumour in patients with airway invasion of thyroid carcinoma. METHODS The records of 34 patients with thyroid cancer with airway invasion were reviewed retrospectively. In addition to total thyroidectomy, airway resection was performed in 18 patients (group 1), whereas the tumour was shaved away from the airway in the other 16 patients (group 2). 131I was used as postoperative adjuvant therapy in all patients. Metastasis and recurrence of the primary lesion were determined by 131I whole-body scans, serum thyroglobulin levels, and computed tomography or ultrasonography of the neck. RESULTS In group 1, two anastomotic dehiscences resulted in one death. Patients in group 2 had a higher rate of local recurrence (relative risk 8.0, P = 0.013) and earlier recurrence (mean(s.e.m.) 2.6(0.8) versus 7.0(1.1) years; P = 0.026) than those in group 1. Median survival was 5.8 and 4.3 years in the 18 patients of group 1 and 16 patients of group 2 (P = 0.259), and the respective 5-year survival rates were 88 and 84 per cent (P = 0.783). CONCLUSION Aggressive airway resection can minimize local recurrence of thyroid carcinoma with airway invasion.
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Affiliation(s)
- Y-F Tsai
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China
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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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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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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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Affleck BD, Swartz K, Brennan J. Surgical considerations and controversies in thyroid and parathyroid surgery. Otolaryngol Clin North Am 2003; 36:159-87, x. [PMID: 12803015 DOI: 10.1016/s0030-6665(02)00135-4] [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: 11/28/2022]
Abstract
The techniques of thyroid surgery have been fully elucidated in several surgical texts and atlases. This article discuss surgical pearls of thyroid and parathyroid surgery. We discuss preoperative, intraoperative, and postoperative considerations and controversies for both procedures.
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Affiliation(s)
- Brian D Affleck
- Department of Otolaryngology/Head and Neck Surgery, Lakenheath Hospital, 48 MDOS/SGOSL, RAF Lakenheath, APO AE 09464, UK
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Behrend M, von Wasielewski R, Klempnauer J. Failure of airway healing in an ovine autotransplantation model that includes basic fibroblast growth factor. J Thorac Cardiovasc Surg 2002; 124:231-40. [PMID: 12167782 DOI: 10.1067/mtc.2002.120335] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Basic fibroblast growth factor is among the most potent promoters of angiogenesis. Its ability to enhance the blood supply to ischemic airways or nonvascularized tracheal autograft has been demonstrated. Its cumulative effect with muscular wrapping and its efficacy in a noncanine large animal model remain unknown. Treatment with basic fibroblast growth factor and muscular wrapping were compared with no special treatment and with muscular wrapping alone in an ovine tracheal autotransplantation model. METHODS All sheep underwent orthotopic tracheal transplantation with 5 to 8 ring autografts in the cervical trachea. Fifteen sheep were classified randomly into the following three groups: no treatment (group A, n = 5), muscular wrapping with the right sternomastoid muscle (group B, n = 5), and topical administration of fibrin glue enriched with 2 microg/cm(2) basic fibroblast growth factor (group C, n = 5). RESULTS Devascularized tracheal autografts were unable to maintain their structural integrity without other treatment (group A). However, the grafts were surrounded by well-vascularized connective tissue. In the muscular wrapping group (group B), infections occurred around the grafts, and the muscular wrapping was subject to necrosis. No neovascularization of the grafts occurred. Therapy with basic fibroblast growth factor (group C) led to improved muscular wrapping circulation and to adherence to the tracheal stumps. However, no success was achieved in validating the circulation in the grafts. CONCLUSIONS In contrast to the results achieved by other authors with canine models, the neovascularization of tracheal autografts was not achieved in sheep with the topical administration of basic fibroblast growth factor. Cranially pediculated muscular wrapping led to poorer circulation in the tissue around the graft than did no therapy at all.
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Affiliation(s)
- Matthias Behrend
- Klinik für Viszeral und Transplantationschirurgie, Medical School Hannover, Hannover, Germany.
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