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Staubitz-Vernazza JI, Schwind S, Lozan O, Musholt TJ. A 16-Year Single-Center Series of Trachea Resections for Locally Advanced Thyroid Carcinoma. Cancers (Basel) 2023; 16:163. [PMID: 38201590 PMCID: PMC10778257 DOI: 10.3390/cancers16010163] [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: 10/16/2023] [Revised: 12/20/2023] [Accepted: 12/24/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Infiltration of the aerodigestive tract in advanced thyroid carcinoma determines the prognosis and quality of life. Different stages of tracheal tumor invasion require customization of the surgical concept. (2) Methods: In the period from January 2007 to January 2023, patients who underwent surgery for advanced thyroid carcinomas with trachea resections were included in a retrospective observational study. The surgical resection concepts and operation-associated complications were documented. The overall survival and post-resection survival were analyzed. (3) Results: From 2007 to 2023, at the single-center UMC Mainz, 33 patients (15 female and 18 male) underwent neck surgery with trachea resections for locally advanced thyroid carcinomas. Of these, 14 were treated with non-transmural (trachea shaving) and 19 transmural trachea resections (9 "window" resections, 6 near-circular resections, 3 sleeve resections and 1 total laryngectomy with extramucosal esophageal resection). The two-year postoperative survival rate was 82.0 percent. The two-year recurrence-free survival rate was 75.0 percent (mean follow-up period: 29.2 months). (4) Conclusions: Tracheal resections for locally advanced tumor infiltration are feasible as an element of highly individualized treatment concepts.
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Affiliation(s)
| | | | | | - Thomas J. Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstraße 1, D-55131 Mainz, Germany; (J.I.S.-V.); (S.S.); (O.L.)
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2
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Shaari D, Dowling E, Urken ML. How I Do It: Sternocleidomastoid Flap Augmentation of Tracheal Repair After Resection for Invasive Thyroid Cancer. Laryngoscope 2023; 133:3228-3231. [PMID: 37067021 DOI: 10.1002/lary.30700] [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: 02/15/2023] [Accepted: 03/24/2023] [Indexed: 04/18/2023]
Abstract
Surgical treatment for thyroid carcinoma invading the trachea often involves circumferential tracheal resection and primary tracheal repair. This procedure involves a significant risk of anastomotic breakdown. We present a novel approach to cricotracheal repair using an SCM flap bolster designed to reduce the risk of anastomotic complications. Laryngoscope, 133:3228-3231, 2023.
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Affiliation(s)
- Diana Shaari
- Thyroid, Head, and Neck Cancer (THANC) Foundation, New York, New York, U.S.A
| | - Eric Dowling
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Mark L Urken
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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3
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Babu A, Lakhera KK, Patel P, Singh S, Sahni M, Nuttaki S, Singhal PM. "Flap of Hope: a Pectoralis Major Muscle Solution for Tracheal Resection Closure": Case Report. Indian J Surg Oncol 2023; 14:553-555. [PMID: 37900641 PMCID: PMC10611632 DOI: 10.1007/s13193-023-01769-x] [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: 04/18/2023] [Accepted: 05/04/2023] [Indexed: 10/31/2023] Open
Abstract
Medullary carcinoma of the thyroid is a rare type of thyroid cancer that arises from the parafollicular cells or C-cells, which produce calcitonin. It accounts for approximately 5-10% of all thyroid cancers (Leboulleux et al. in Clin Endocrinol 61(3):299-310, 2004). The main treatment for medullary thyroid carcinoma is surgery, which involves the removal of the thyroid gland and any affected lymph nodes. In advanced cases where the cancer has spread to nearby structures such as the trachea (Gupta et al. in Indian J Surg Oncol 11(1):75-79, 2020), tracheal resection followed by reconstruction may be necessary to remove the cancer (Chernichenko et al. in Curr Opin Oncol 24(1):29-34, 2012) and restore proper breathing, closure of large tracheal defect can be done with pectoralis major myocutaneous flap (Salmerón-González et al. Plast Surg Nurs 38. 162-165, 2018). In this article, we report a case of recurrent medullary carcinoma thyroid with tracheal infiltration and tracheal resection was done, both of which is extremely rare. A 38-year-old male patient with a history of total thyroidectomy presented with recurrence was referred to our department, his previous biopsy and IHC revealed medullary carcinoma thyroid. Ga-68 DOTA PET CT scan was done which showed PET avid residual mass over right side, multiple bilateral cervical nodes, and tracheal infiltration (Fig. 1) then underwent a bronchoscopy showing involvement of the second, third, and fourth tracheal ring. Bilateral neck dissection with sleeve resection of trachea with overlying residual tumor was done and was sent for frozen which revealed positive margins and re-excision of margins was done, which lead to large defect (Fig. 2) which could not be closed primarily with a Montgomery T Tube. A de-epithelized pectoralis major myocutaneous flap used to close the tracheal defect followed by placing the Montgomery T Tube (Fig. 3).Post-operative period was uneventful. The final histopathology report showed R0 resection of tumor. T tube was removed after 4 weeks.
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Affiliation(s)
- Agil Babu
- Department of Surgical Oncology, SMS Medical College, Jaipur Rajasthan, India
| | | | - Pinakin Patel
- Department of Surgical Oncology, SMS Medical College, Jaipur Rajasthan, India
| | - Suresh Singh
- Department of Surgical Oncology, SMS Medical College, Jaipur Rajasthan, India
| | - Manish Sahni
- Department of Surgical Oncology, SMS Medical College, Jaipur Rajasthan, India
| | - Srikanth Nuttaki
- Department of Surgical Oncology, SMS Medical College, Jaipur Rajasthan, India
| | - Pranav M. Singhal
- Department of Surgical Oncology, SMS Medical College, Jaipur Rajasthan, India
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4
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Enomoto K, Inohara H. Surgical strategy of locally advanced differentiated thyroid cancer. Auris Nasus Larynx 2023; 50:23-31. [PMID: 35314084 DOI: 10.1016/j.anl.2022.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 02/16/2022] [Accepted: 03/04/2022] [Indexed: 01/28/2023]
Abstract
Approximately 20% of patients with differentiated thyroid cancer (DTC) have direct tumor extension with invasion of the surrounding tissues such as the larynx, trachea, esophagus, or recurrent laryngeal nerve. Recent progress of molecular-targeted therapy, such as the use of tyrosine kinase inhibitors, improves survival outcome in patients with advanced DTC. However, induction of tyrosine kinase inhibitors for locally-advanced DTC has presented novel fatal adverse events including fistula in patients with infiltration toward to the trachea, pharynx and esophagus, and fatal bleeding in patients with great vessel invasion. Surgery therefore still has an important role in DTC management, particularly in local control. The surgical strategy for laryngeal/tracheal invasion, which commonly occurs by DTC, is decided according to the extension (depths and area) of the tumor. The "shave procedure" is performed when the tumor has superficially invaded the larynx/trachea. However, intra-luminal extension requires resection and reconstruction of the larynx/trachea wall. Large veins, such as the internal jugular vein and the subclavian vein, are also frequently directly invaded by DTC. Three types of jugular vein reconstruction have been advocated to avoid fatal complications according to bilateral jugular vein ligation. The majority of carotid artery invasion by DTC can be managed with tumor resection of the sub-adventitial layer without reconstruction surgery using an artificial vessel. In this review article, we examine surgery for advanced DTC, showing the surgical strategy toward DTC that has invaded the laryngotracheal, recurrent laryngeal nerve, esophagus/hypopharynx, or great vessels.
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Affiliation(s)
- Keisuke Enomoto
- Department of Otolaryngology-Head and Neck Surgery, Wakayama Medical University, Wakayama, Japan.
| | - Hidenori Inohara
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
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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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Liu Y, Huang N, Xu W, Liu J, An C, Zhu Y, Liu S, Zhang Z. A modified tracheal transection approach for cervical esophageal lesion treatment: A report of 13 cases. Front Surg 2022; 9:1001488. [PMID: 36338615 PMCID: PMC9634415 DOI: 10.3389/fsurg.2022.1001488] [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: 07/23/2022] [Accepted: 10/03/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Surgical interventions for tumors in the cervical esophageal region are complicated and laryngeal function is frequently sacrificed. Therefore, we attempted the tracheal transection approach to resect the tumor while preserving laryngeal function. METHODS Three patients with papillary thyroid cancer (PTC), six with cervical esophageal cancer (CEC), and four with CEC mixed with thoracic esophageal cancer (TEC) were enrolled. The esophagus was exposed after the trachea was transected between the second and third tracheal rings. CEC/TEC: Resection of the esophagus or/and a portion of the hypopharynx with acceptable safety margins and repair with free jejunum or tubular stomach. PTC: Suture the small esophageal incision immediately after removing the tumor. The tracheal dissection was repaired with interrupted sutures throughout the entire layer after the esophageal lesion was resected. The status of the recurrent laryngeal nerve (RLN) determined whether a tracheotomy was necessary. RESULTS All 13 patients had effective esophageal lesion excision, with six of them requiring intraoperative tracheotomy. Postoperative complications included a tracheoesophageal fistula (one case, 7.7%), postoperative RLN paralysis (two cases, 15.4%), and aspiration (three cases, 23.1%). Except for two patients with distant metastases, there was no recurrence in the remaining patients after 5-92 months of follow-up. CONCLUSION The tracheal transection approach, as a new surgical technique, can retain laryngeal function while ensuring appropriate exposure and satisfactory surgical resection. Before surgery, the feasibility of this approach must be carefully assessed. The RLN should be protected during the procedure. The operation is both safe and effective, with a wide range of applications.
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Affiliation(s)
- Yang Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nan Huang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Xu
- Department of Head and Neck Surgery, Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jie Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Changming An
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiming Zhu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shaoyan Liu
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zongmin Zhang
- Department of Head and Neck Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,Correspondence: Zongmin Zhang
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Bulfamante AM, Lori E, Bellini MI, Bolis E, Lozza P, Castellani L, Saibene AM, Pipolo C, Fuccillo E, Rosso C, Felisati G, De Pasquale L. Advanced Differentiated Thyroid Cancer: A Complex Condition Needing a Tailored Approach. Front Oncol 2022; 12:954759. [PMID: 35875142 PMCID: PMC9300941 DOI: 10.3389/fonc.2022.954759] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/13/2022] [Indexed: 12/28/2022] Open
Abstract
Differentiated thyroid cancers (DTCs) are slow-growing malignant tumours, including papillary and follicular carcinomas. Overall, prognosis is good, although it tends to worsen when local invasion occurs with bulky cervical nodes, or in the case of distant metastases. Surgery represents the main treatment for DTCs. However, radical excision is challenging and significant morbidity and functional loss can follow the treatment of the more advanced forms. Literature on advanced thyroid tumours, both differentiated and undifferentiated, does not provide clear and specific guidelines. This emerges the need for a tailored and multidisciplinary approach. In the present study, we report our single-centre experience of 111 advanced (local, regional, and distant) DTCs, investigating the rate of radical excision, peri-procedural and post-procedural complications, quality of life, persistence, recurrence rates, and survival rates. Results are critically appraised and compared to the existing published evidence review.
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Affiliation(s)
- Antonio Mario Bulfamante
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Eleonora Lori
- Department of Surgical Sciences, “Sapienza” University of Rome, Rome, Italy
- *Correspondence: Eleonora Lori,
| | | | | | - Paolo Lozza
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Luca Castellani
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Alberto Maria Saibene
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Carlotta Pipolo
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Emanuela Fuccillo
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Cecilia Rosso
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Giovanni Felisati
- Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
| | - Loredana De Pasquale
- Thyroid and Parathyroid Surgery Service-Otolaryngology Unit, ASST Santi Paolo e Carlo, Department of Health Sciences, University of Milan, Milan, Italy
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Piazza C, Lancini D, Tomasoni M, D’Cruz A, Hartl DM, Kowalski LP, Randolph GW, Rinaldo A, Shah JP, Shaha AR, Simo R, Vander Poorten V, Zafereo M, Ferlito A. Tracheal and Cricotracheal Resection With End-to-End Anastomosis for Locally Advanced Thyroid Cancer: A Systematic Review of the Literature on 656 Patients. Front Endocrinol (Lausanne) 2021; 12:779999. [PMID: 34858348 PMCID: PMC8632531 DOI: 10.3389/fendo.2021.779999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 10/27/2021] [Indexed: 11/13/2022] Open
Abstract
Airway involvement by advanced thyroid carcinoma (TC) constitutes a negative prognosticator, besides being a critical clinical issue since it represents one of the most frequent causes of death in locally advanced disease. It is generally agreed that, for appropriate laryngo-tracheal patterns of invasion, (crico-)tracheal resection and primary anastomosis [(C)TRA] is the preferred surgical technique in this clinical scenario. However, the results of long-term outcomes of (C)TRA are scarce in the literature, due to the rarity of such cases. The relative paucity of data prompts careful review of the available relevant series in order to critically evaluate this surgical technique from the oncologic and functional points of view. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement on the PubMed, Scopus, and Web of Science databases. English-language surgical series published between January 1985 and August 2021, reporting data on ≥5 patients treated for TC infiltrating the airway by (C)TRA were included. Oncologic outcomes, mortality, complications, and tracheotomy-dependency rates were assessed. Pooled proportion estimates were elaborated for each end-point. Thirty-seven studies were included, encompassing a total of 656 patients. Pooled risk of perioperative mortality was 2.0%. Surgical complications were reported in 27.0% of patients, with uni- or bilateral recurrent laryngeal nerve palsy being the most common. Permanent tracheotomy was required in 4.0% of patients. Oncologic outcomes varied among different series with 5- and 10-year overall survival rates ranging from 61% to 100% and 42.1% to 78.1%, respectively. Five- and 10-year disease specific survival rates ranged from 75.8% to 90% and 54.5% to 62.9%, respectively. Therefore, locally advanced TC with airway invasion treated with (C)TRA provides acceptable oncologic outcomes associated with a low permanent tracheotomy rate. The reported incidence of complications, however, indicates the need for judicious patient selection, meticulous surgical technique, and careful postoperative management.
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Affiliation(s)
- Cesare Piazza
- Unit of Otorhinolaryngology – Head and Neck Surgery, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili of Brescia, Brescia, Italy
- Department of Medical, Surgical and Radiological Sciences and Public Health, School of Medicine, University of Brescia, Brescia, Italy
| | - Davide Lancini
- Unit of Otorhinolaryngology – Head and Neck Surgery, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili of Brescia, Brescia, Italy
| | - Michele Tomasoni
- Unit of Otorhinolaryngology – Head and Neck Surgery, Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili of Brescia, Brescia, Italy
- Department of Medical, Surgical and Radiological Sciences and Public Health, School of Medicine, University of Brescia, Brescia, Italy
| | - Anil D’Cruz
- Director Oncology Apollo Group of Hospitals, Mumbai, India
| | - Dana M. Hartl
- Department of Head and Neck Oncology, Gustave Roussy, Université Paris Saclay, Paris, France
| | - Luiz P. Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School and Antonio Cândido (AC) Camargo Cancer Center, Sao Paulo, Brazil
| | - Gregory W. Randolph
- John and Claire Bertucci Endowed Chair in Thyroid Surgical Oncology, Harvard Medical School, Boston, MA, United States
| | | | - Jatin P. Shah
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY, United States
- Department of Oncology, Radiotherapy and Plastic Surgery, Sechenov University, Moscow, Russia
| | - Ashok R. Shaha
- Jatin P Shah Chair in Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ricard Simo
- Department of Otorhinolaryngology – Head and Neck Surgery, Head, Neck and Thyroid Oncology Unit, Guy’s and St Thomas’ Hospital National Health Service (NHS) Foundation Trust and King’s College London, London, United Kingdom
| | - Vincent Vander Poorten
- Otorhinolaryngology – Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Oncology, Section Head and Neck Oncology, Katholieke Universiteit (KU) Leuven, Leuven, Belgium
| | - Mark Zafereo
- Division of Surgery, Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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9
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Matsumoto F, Ikeda K. Surgical Management of Tracheal Invasion by Well-Differentiated Thyroid Cancer. Cancers (Basel) 2021; 13:cancers13040797. [PMID: 33672929 PMCID: PMC7918429 DOI: 10.3390/cancers13040797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 01/25/2023] Open
Abstract
Simple Summary Tracheal invasion is a poor prognostic factor in well-differentiated thyroid cancer. Appropriate resection can improve the prognosis and maintain the patient’s quality of life. Shaving resection for superficial tracheal invasion is minimally invasive because it does not involve the tracheal lumen, despite the problematic risk of local recurrence. Window resection for tracheal mucosal and luminal invasion provides good tumor control and does not cause postoperative airway obstruction; however, the need for surgical closure of the tracheocutaneous fistula is a disadvantage of this method. Circumferential (sleeve) resection and end-to-end anastomosis are highly curative, but the risk of fatal complications, such as anastomosis dehiscence, is a concern. Abstract Well-differentiated thyroid carcinoma (WDTC) is a slow-growing cancer with a good prognosis, but may show extraglandular progression involving the invasion of tumor-adjacent tissues, such as the trachea, esophagus, and recurrent laryngeal nerve. Tracheal invasion by WDTC is infrequent. Since this condition is rare, relevant high-level evidence about it is lacking. Tracheal invasion by a WDTC has a negative impact on survival, with intraluminal tumor development constituting a worse prognostic factor than superficial tracheal invasion. In WDTC, curative resection is often feasible with a small safety margin, and complete resection can ensure a good prognosis. Despite its resectability, accurate knowledge of the tracheal and peritracheal anatomy and proper selection of surgical techniques are essential for complete resection. However, there is no standard guideline on surgical indications and the recommended procedure in trachea-invading WDTC. This review discusses the indications for radical resection and the three currently available major resection methods: shaving, window resection, and sleeve resection with end-to-end anastomosis. The review shows that the decision for radical resection should be based on the patient’s general condition, tumor status, expected survival duration, and the treating facility’s strengths and weaknesses.
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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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Ito Y, Onoda N, Okamoto T. The revised clinical practice guidelines on the management of thyroid tumors by the Japan Associations of Endocrine Surgeons: Core questions and recommendations for treatments of thyroid cancer. Endocr J 2020; 67:669-717. [PMID: 32269182 DOI: 10.1507/endocrj.ej20-0025] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Japan Associations of Endocrine Surgeons has developed the revised version of the Clinical Practice Guidelines for Thyroid Tumors. This article describes the guidelines translated into English for the 35 clinical questions relevant to the therapeutic management of thyroid cancers. The objective of the guidelines is to improve health-related outcomes in patients with thyroid tumors by enabling users to make their practice evidence-based and by minimizing any variations in clinical practice due to gaps in evidential knowledge among physicians. The guidelines give representative flow-charts on the management of papillary, follicular, medullary, and anaplastic thyroid carcinoma, along with recommendations for clinical questions by presenting evidence on the relevant outcomes including benefits, risks, and health conditions from patients' perspective. Therapeutic actions were recommended or not recommended either strongly (◎◎◎ or XXX) based on good evidence (😊)/good expert consensus (+++), or weakly (◎, ◎◎ or X, XX) based on poor evidence (😣)/poor expert consensus (+ or ++). Only 10 of the 51 recommendations given in the guidelines were supported by good evidence, whereas 35 were supported by good expert consensus. While implementing the current guidelines would be of help to achieve the objective, we need further clinical research to make our shared decision making to be more evidence-based.
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Affiliation(s)
- Yasuhiro Ito
- Department of Clinical Trial, Kuma Hospital, Kobe 650-0011, Japan
| | - Naoyoshi Onoda
- Department of Breast and Endocrine Surgery, Osaka City University Graduate School of Medicine, Osaka 545-8585, Japan
| | - Takahiro Okamoto
- Department of Breast and Endocrine Surgery, Tokyo Women's Medical University, Tokyo 162-8666, Japan
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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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Chen W, Zou S, Wang L, Wu C, Wang Z, Li K, Zhang S. Anastomosis in the absence of a suprahyoid release following circumferential sleeve resection is feasible in differentiated thyroid carcinoma patients with tracheal invasion. Oncol Lett 2017; 14:2822-2830. [PMID: 28927041 PMCID: PMC5588125 DOI: 10.3892/ol.2017.6568] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 01/19/2017] [Indexed: 11/22/2022] Open
Abstract
Invasion of the trachea is observed in ~6% of patients with differentiated thyroid carcinoma (DTC), and surgery is accepted as the treatment of choice. However, surgical procedures can be challenging and are associated with various risks. The authors of the present study performed a retrospective study of patients with DTC and tumor invasion of the trachea. Outcomes from patients that received circumferential sleeve resection (CSR) of the trachea followed by anastomosis in the absence of suprahyoid release (n=21; CSR group) and patients that underwent tangential resections [n=103; tangential ‘shave’ resection (TSR) group) were analyzed. In the CSR group, 4 to 8 tracheal rings were circumferentially resected. All patients underwent end-to-end anastomosis in the absence of suprahyoid release following CSR, and 7 patients developed cancer metastasis following surgery. With the exception of 2 patients that succumbed to disease, the remaining patients in the CSR group survived without cancer recurrence. In the TSR group, all of the patients experienced cancer recurrence within five years post-surgery. A total of 61 patients developed metastases in the three years following surgery, and 71 patients succumbed to cancer metastasis within five years. The survival rate of the CSR group was significantly increased compared with the TSR group. The results of the present study suggest that in DTC patients with defects involving up to 8 tracheal rings, it may be appropriate to perform anastomosis without suprahyoid tissue release as it is associated with a reduced incidence of perioperative morbidity.
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Affiliation(s)
- Wanjun Chen
- Department of Head and Neck Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Shujuan Zou
- Department of Head and Neck Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Liang Wang
- Department of Head and Neck Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Changhua Wu
- Department of Head and Neck Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Zhiqi Wang
- Department of Head and Neck Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Ke Li
- Department of Head and Neck Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Shuguang Zhang
- Department of Head and Neck Surgery, Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
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Window Resection for Intraluminal Cricotracheal Invasion by Papillary Thyroid Carcinoma. World J Surg 2017; 41:1812-1819. [DOI: 10.1007/s00268-017-3927-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Nixon IJ, Simo R, Newbold K, Rinaldo A, Suarez C, Kowalski LP, Silver C, Shah JP, Ferlito A. Management of Invasive Differentiated Thyroid Cancer. Thyroid 2016; 26:1156-66. [PMID: 27480110 PMCID: PMC5118958 DOI: 10.1089/thy.2016.0064] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Invasive disease is a poor prognostic factor for patients with differentiated thyroid cancer (DTC). Uncontrolled central neck disease is a common cause of distressing death for patients presenting in this manner. Advances in assessment and management of such cases have led to significant improvements in outcome for this patient group. This article reviews the patterns of invasion and a contemporary approach to investigation and treatment of patients with invasive DTC. SUMMARY Aerodigestive tract invasion is reported in around 10% of case series of DTC. Assessment should include not only clinical history and physical examination with endoscopy as indicated, but ultrasound and contrast-enhanced cross-sectional imaging. Further studies including positron emission tomography should be considered, particularly in recurrent cases that are radioactive iodine (RAI) resistant. Both the patient and the extent of disease should be carefully assessed prior to embarking on surgery. The aim of surgery is to resect all gross disease. When minimal visceral invasion is encountered early, "shave" procedures are recommended. In the setting of transmural invasion of the airway or esophagus, however, full thickness excision is required. For intermediate cases in which invasion of the viscera has penetrated the superficial layers but is not evident in the submucosa, opinion is divided. Early reports recommended an aggressive approach. More recently authors have tended to recommend less aggressive resections with postoperative adjuvant therapies. The role of external beam radiotherapy continues to evolve in DTC with support for its use in patients considered to have RAI-resistant tumors. CONCLUSIONS Patients with invasive DTC require a multidisciplinary approach to investigation and treatment. With detailed assessment, appropriate surgery, and adjuvant therapy when indicated, this patient group can expect durable control of central neck disease, despite the aggressive nature of their primary tumors.
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Affiliation(s)
- Iain J. Nixon
- NHS Lothian/Edinburgh University, Edinburgh, United Kingdom
| | - Ricard Simo
- Head and Neck Cancer Unit, Guy's and St Thomas' Hospital, NHS Foundation Trust, London, United Kingdom
| | - Kate Newbold
- NIHR Royal Marsden Hospital and Institute of Cancer Research BRC, London, United Kingdom
| | | | - Carlos Suarez
- Department of Surgery, Universidad de Oviedo, Oviedo, Spain
| | - Luiz P. Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Carl Silver
- Departments of Surgery and Otolaryngology – Head and Neck Surgery, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Jatin P. Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alfio Ferlito
- Former Director of the Department of Surgical Sciences and Chairman of the ENT Clinic at the University of Udine School of Medicine, Udine, Italy
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Yi KH, Lee EK, Kang HC, Koh Y, Kim SW, Kim IJ, Na DG, Nam KH, Park SY, Park JW, Bae SK, Baek SK, Baek JH, Lee BJ, Chung KW, Jung YS, Cheon GJ, Kim WB, Chung JH, Rho YS. 2016 Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.11106/ijt.2016.9.2.59] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Ka Hee Yi
- Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Korea
| | - Eun Kyung Lee
- Department of Internal Medicine, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Yunwoo Koh
- Department of Otorhinolaryngology, College of Medicine, Yonsei University, Korea
| | - Sun Wook Kim
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - In Joo Kim
- Department of Internal Medicine, College of Medicine, Pusan National University, Korea
| | - Dong Gyu Na
- Department of Radiology, Human Medical Imaging and Intervention Center, Korea
| | - Kee-Hyun Nam
- Department of Surgery, College of Medicine, Yonsei University, Korea
| | - So Yeon Park
- Department of Pathology, Seoul National University College of Medicine, Korea
| | - Jin Woo Park
- Department of Surgery, College of Medicine, Chungbuk National University, Korea
| | - Sang Kyun Bae
- Department of Nuclear Medicine, Inje University College of Medicine, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology, College of Medicine, Korea University, Korea
| | - Jung Hwan Baek
- Department of Radiology, University of Ulsan College of Medicine, Korea
| | - Byung-Joo Lee
- Department of Otorhinolaryngology, College of Medicine, Pusan National University, Korea
| | - Ki-Wook Chung
- Department of Surgery, University of Ulsan College of Medicine, Korea
| | - Yuh-Seog Jung
- Department of Otorhinolaryngology, Center for Thyroid Cancer, National Cancer Center, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University College of Medicine, Korea
| | - Won Bae Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Korea
| | - Jae Hoon Chung
- Department of Medicine, Thyroid Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
| | - Young-Soo Rho
- Department of Otorhinolaryngology, Hallym University College of Medicine, Korea
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Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE, Pacini F, Randolph GW, Sawka AM, Schlumberger M, Schuff KG, Sherman SI, Sosa JA, Steward DL, Tuttle RM, Wartofsky L. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer: The American Thyroid Association Guidelines Task Force on Thyroid Nodules and Differentiated Thyroid Cancer. Thyroid 2016; 26:1-133. [PMID: 26462967 PMCID: PMC4739132 DOI: 10.1089/thy.2015.0020] [Citation(s) in RCA: 8521] [Impact Index Per Article: 1065.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the American Thyroid Association's (ATA's) guidelines for the management of these disorders were revised in 2009, significant scientific advances have occurred in the field. The aim of these guidelines is to inform clinicians, patients, researchers, and health policy makers on published evidence relating to the diagnosis and management of thyroid nodules and differentiated thyroid cancer. METHODS The specific clinical questions addressed in these guidelines were based on prior versions of the guidelines, stakeholder input, and input of task force members. Task force panel members were educated on knowledge synthesis methods, including electronic database searching, review and selection of relevant citations, and critical appraisal of selected studies. Published English language articles on adults were eligible for inclusion. The American College of Physicians Guideline Grading System was used for critical appraisal of evidence and grading strength of recommendations for therapeutic interventions. We developed a similarly formatted system to appraise the quality of such studies and resultant recommendations. The guideline panel had complete editorial independence from the ATA. Competing interests of guideline task force members were regularly updated, managed, and communicated to the ATA and task force members. RESULTS The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, use of molecular markers, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to screening for thyroid cancer, staging and risk assessment, surgical management, radioiodine remnant ablation and therapy, and thyrotropin suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using imaging and serum thyroglobulin, thyroid hormone therapy, management of recurrent and metastatic disease, consideration for clinical trials and targeted therapy, as well as directions for future research. CONCLUSIONS We have developed evidence-based recommendations to inform clinical decision-making in the management of thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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Affiliation(s)
| | - Erik K. Alexander
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Susan J. Mandel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | | | | | - Gregory W. Randolph
- Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Anna M. Sawka
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Julie Ann Sosa
- Duke University School of Medicine, Durham, North Carolina
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Piazza C, Del Bon F, Barbieri D, Grazioli P, Paderno A, Perotti P, Lombardi D, Peretti G, Nicolai P. Tracheal and Crico-Tracheal Resection and Anastomosis for Malignancies Involving the Thyroid Gland and the Airway. Ann Otol Rhinol Laryngol 2015; 125:97-104. [DOI: 10.1177/0003489415599000] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Objectives: To evaluate outcomes in different malignancies involving the thyroid and infiltrating the airway submitted to tracheal (TRA) or crico-tracheal resection and anastomosis (CTRA). Methods: Retrospective charts review of 27 patients affected by thyroid malignancies involving the airway treated by TRA/CTRA in a single academic institution. Kaplan-Meier curves were used to evaluate the overall (OS) and disease-specific (DSS) survivals and local (LC) and loco-regional control (LRC). Impact on survival of age, comorbidities, previous radiotherapy, types of TRA/CTRA, Shin’s stage (II, III, IV), grading (well vs poorly differentiated), and length of airway resected was calculated by the log-rank test. Results: Overall survival and DSS at 3 and 5 years were 82.3% and 71.6%, respectively. Local control and LRC in the entire group were 82.3% at 3 and 5 years. Crico-tracheal resection and anastomosis involving the cricoid arch and plate (type C) and tumor differentiation significantly affected OS and DSS (both P < .001). Type C CTRA and tumor differentiation significantly impacted on LC ( P = .002 and P = .009, respectively). Conclusions: Grading and extension of CTRA to the cricoid plate are the most important factors for oncologic outcomes in thyroid malignancies infiltrating the airway. Except for poorly differentiated tumors, TRA/CTRA allows adequate LC even in advanced stage lesions involving the crico-tracheal junction.
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Affiliation(s)
- Cesare Piazza
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Francesca Del Bon
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Diego Barbieri
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Paola Grazioli
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Alberto Paderno
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Pietro Perotti
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Davide Lombardi
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
| | - Giorgio Peretti
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Genoa, Genoa, Italy
| | - Piero Nicolai
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Brescia, Brescia, Italy
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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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Classification of aerodigestive tract invasion from thyroid cancer. Langenbecks Arch Surg 2013; 399:209-16. [PMID: 24271275 DOI: 10.1007/s00423-013-1142-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 11/05/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND Widely invasive extrathyroidal thyroid cancer invading the aerodigestive tract (ADT) including larynx, trachea, hypopharynx, and/or esophagus occurs in 1-8 % of patients with thyroid cancer and is classified as T4a (current UICC/AJCC system). The T4a stage is associated with impaired tumor-free survival and increased disease-specific mortality. Concerning prognosis and outcome, further subdivisions of the T4a stage, however, have not been made so far. METHODS This study is based on a systematic review of the relevant literature in the PubMed database. RESULTS Retrospective studies suggest a better outcome in patients with invasion of the trachea or the esophagus when compared to laryngeal invasion. Regarding surgical strategies, ADT invasion can be classified based on a three-dimensional assessment determining surgical resection options. Regardless of the invaded structure, tumor infiltration of the ADT can be subdivided into superficial, deep extraluminal, and intraluminal invasion. In contrast to superficial ADT invasion, allowing tangential incomplete wall resection (shaving/extramucosal esophagus resection), deeper wall and intraluminal invasions require complete wall resection (either window or sleeve). Based on the Dralle classification (types 1-6), particularly airway invasion, can be further classified according to the vertical and horizontal extents of tumor invasion. CONCLUSIONS The Dralle classification can be considered as a reliable subdivision system evaluated regarding surgical options as well as oncological outcome. However, further studies determining the prognostic impact of this technically oriented classification system are required.
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Tsutsui H, Hoshi M, Kubota M, Suzuki A, Nakamura N, Usuda J, Shibuya H, Miyajima K, Ohira T, Ito K, Ikeda N. Management of thyroid carcinoma showing thymus-like differentiation (CASTLE) invading the trachea. Surg Today 2013; 43:1261-8. [PMID: 23543082 DOI: 10.1007/s00595-013-0560-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 08/12/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE To define the clinicopathological features and discuss the optimal management of carcinoma showing thymus-like differentiation (CASTLE). METHODS We retrospectively analyzed six patients with CASTLE. RESULTS The subjects comprised two men and four women (average age at initial diagnosis, 61 years, range 47-75 years). Preoperative biopsy yielded a correct diagnosis in two patients. Five patients underwent surgery and one was treated with radiation therapy alone. Four had extrathyroidal invasion and three had lymph node metastasis. During the clinical course, tracheal invasion was detected in five patients, the upper extent of the tumor being the lower half of the first tracheal ring. Two of these patients underwent tracheal sleeve resection. Two patients received postoperative radiotherapy for nodal metastasis, and one, after palliative surgery. The median follow-up period was 67 months (range 38-129). Recurrence was found 10 years post-therapy in the patient treated with radiation therapy only, resulting in death soon after. Although local recurrence was not found in the remaining five patients, new pulmonary metastases were diagnosed in the patient who underwent non-curative surgery. CONCLUSIONS CASTLE can be diagnosed preoperatively by core needle biopsy and CD5 staining. Curative resection with neck dissection followed by radiotherapy can yield a good outcome. Larynx-sparing complete resection may be more feasible for CASTLE, even though it has a higher incidence of tracheal invasion than differentiated thyroid carcinoma.
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Affiliation(s)
- Hidemitsu Tsutsui
- Department of Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan,
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Dralle H, Musholt TJ, Schabram J, Steinmüller T, Frilling A, Simon D, Goretzki PE, Niederle B, Scheuba C, Clerici T, Hermann M, Kußmann J, Lorenz K, Nies C, Schabram P, Trupka A, Zielke A, Karges W, Luster M, Schmid KW, Vordermark D, Schmoll HJ, Mühlenberg R, Schober O, Rimmele H, Machens A. German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors. Langenbecks Arch Surg 2013; 398:347-75. [PMID: 23456424 DOI: 10.1007/s00423-013-1057-6] [Citation(s) in RCA: 150] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 01/30/2013] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Over the past years, the incidence of thyroid cancer has surged not only in Germany but also in other countries of the Western hemisphere. This surge was first and foremost due to an increase of prognostically favorable ("low risk") papillary thyroid microcarcinomas, for which limited surgical procedures are often sufficient without loss of oncological benefit. These developments called for an update of the previous practice guideline to detail the surgical treatment options that are available for the various disease entities and tumor stages. METHODS The present German Association of Endocrine Surgeons practice guideline was developed on the basis of clinical evidence considering current national and international treatment recommendations through a formal expert consensus process in collaboration with the German Societies of General and Visceral Surgery, Endocrinology, Nuclear Medicine, Pathology, Radiooncology, Oncological Hematology, and a German thyroid cancer patient support organization. RESULTS The practice guideline for the surgical management of malignant thyroid tumors includes recommendations regarding preoperative workup; classification of locoregional nodes and terminology of surgical procedures; frequency, clinical, and histopathological features of occult and clinically apparent papillary, follicular, poorly differentiated, undifferentiated, and sporadic and hereditary medullary thyroid cancers, thyroid lymphoma and thyroid metastases from primaries outside the thyroid gland; extent of thyroidectomy; extent of lymph node dissection; aerodigestive tract resection; postoperative follow-up and surgery for recurrence and distant metastases. CONCLUSION These evidence-based recommendations for surgical therapy reflect various "treatment corridors" that are best discussed within multidisciplinary teams and the patient considering tumor type, stage, progression, and inherent surgical risk.
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Affiliation(s)
- Henning Dralle
- Department of General, Visceral and Vascular Surgery, Martin Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06097, Halle, Saale, Germany.
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Bush CM, Prosser JD, Morrison MP, Sandhu G, Wenger KH, Pashley DH, Birchall MA, Postma GN, Weinberger PM. New technology applications: Knotless barbed suture for tracheal resection anastomosis. Laryngoscope 2012; 122:1062-6. [PMID: 22473356 DOI: 10.1002/lary.23229] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 12/31/2011] [Accepted: 01/09/2012] [Indexed: 12/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS Tracheal resection anastomoses are often under tension and can be technically challenging. New suture materials such as V-loc (barbed, knotless wound closure device) may offer advantages over conventional methods. The objective of this study is to determine if a running V-loc suture is of comparable tensile strength to conventional closure. STUDY DESIGN Laboratory based study of human cadaveric tissue. METHODS Fresh human cadaveric tracheas were dissected and incised into segments. Anastomosis of adjacent segments was then performed with either submucosal interrupted 3-0 Vicryl, or a running submucosal 3-0 V-loc suture. Anastomosed specimens were stretched to failure on an Instron force tension machine. Surgeon satisfaction was recorded by visual analog scale (VAS). RESULTS The tensile strength of 12 tracheal anastomoses was tested. Video documentation of V-loc suture technique and anastomosis failure was recorded. In both Vicryl (80%) and V-loc (100%) anastomoses, failure occurred at the membranous intercartilaginous region. In 20% of the Vicryl anastomoses, the suture was noted to break prior to tissue failure. Anastomoses with V-loc suture had equivalent failure force (mean, 59 N) compared to interrupted Vicryl (51 N), with P = .57. On VAS, surgeons were more satisfied with V-loc suture closure compared to interrupted Vicryl closure (paired t test, P = .003). CONCLUSIONS Tracheal anastomosis with running v-loc suture is a feasible alternative to conventional closure with interrupted Vicryl suture. V-loc suture provided a surgical advantage by improved ease of use.
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Affiliation(s)
- Carrie M Bush
- Department of Otolaryngology and Center for Voice, Airway, and Swallowing Disorders, Georgia Health Sciences University, Augusta, Georgia, USA
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Differentiated thyroid cancer: management of patients with radioiodine nonresponsive disease. J Thyroid Res 2012; 2012:618985. [PMID: 22530159 PMCID: PMC3316972 DOI: 10.1155/2012/618985] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 11/21/2011] [Accepted: 11/21/2011] [Indexed: 01/03/2023] Open
Abstract
Differentiated thyroid carcinoma (papillary and follicular) has a favorable prognosis with an 85% 10-year survival. The patients that recur often require surgery and further radioactive iodine to render them disease-free. Five percent of thyroid cancer patients, however, will eventually succumb to their disease. Metastatic thyroid cancer is treated with radioactive iodine if the metastases are radioiodine avid. Cytotoxic chemotherapies for advanced or metastatic noniodine avid thyroid cancers show no prolonged responses and in general have fallen out of favor. Novel targeted therapies have recently been discovered that have given rise to clinical trials for thyroid cancer. Newer aberrations in molecular pathways and oncogenic mutations in thyroid cancer together with the role of angiogenesis in tumor growth have been central to these discoveries. This paper will focus on the management and treatment of metastatic differentiated thyroid cancers that do not take up radioactive iodine.
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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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Revised Korean Thyroid Association Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. ACTA ACUST UNITED AC 2011. [DOI: 10.3342/kjorl-hns.2011.54.1.8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Brauckhoff M, Machens A, Thanh PN, Lorenz K, Schmeil A, Stratmann M, Sekulla C, Brauckhoff K, Dralle H. Impact of extent of resection for thyroid cancer invading the aerodigestive tract on surgical morbidity, local recurrence, and cancer-specific survival. Surgery 2010; 148:1257-66. [DOI: 10.1016/j.surg.2010.09.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Accepted: 09/14/2010] [Indexed: 11/29/2022]
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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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Manejo multidisciplinario del cáncer diferenciado de tiroides en el Instituto Nacional de Cancerología. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s0123-9015(10)70100-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Pacini F, Schlumberger M, Sherman SI, Steward DL, Tuttle RM. Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2009; 19:1167-214. [PMID: 19860577 DOI: 10.1089/thy.2009.0110] [Citation(s) in RCA: 4635] [Impact Index Per Article: 309.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Thyroid nodules are a common clinical problem, and differentiated thyroid cancer is becoming increasingly prevalent. Since the publication of the American Thyroid Association's guidelines for the management of these disorders was published in 2006, a large amount of new information has become available, prompting a revision of the guidelines. METHODS Relevant articles through December 2008 were reviewed by the task force and categorized by topic and level of evidence according to a modified schema used by the United States Preventative Services Task Force. RESULTS The revised guidelines for the management of thyroid nodules include recommendations regarding initial evaluation, clinical and ultrasound criteria for fine-needle aspiration biopsy, interpretation of fine-needle aspiration biopsy results, and management of benign thyroid nodules. Recommendations regarding the initial management of thyroid cancer include those relating to optimal surgical management, radioiodine remnant ablation, and suppression therapy using levothyroxine. Recommendations related to long-term management of differentiated thyroid cancer include those related to surveillance for recurrent disease using ultrasound and serum thyroglobulin as well as those related to management of recurrent and metastatic disease. CONCLUSIONS We created evidence-based recommendations in response to our appointment as an independent task force by the American Thyroid Association to assist in the clinical management of patients with thyroid nodules and differentiated thyroid cancer. They represent, in our opinion, contemporary optimal care for patients with these disorders.
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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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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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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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Kim WB, Kim TY, Kwon HS, Moon WJ, Lee JB, Choi YS, Kim SK, Kim SW, Chung KW, Baek JH, Kim BI, Park DJ, Na DG, Choe JH, Chung JH, Jung HS, Kim JH, Nam KH, Chang HS, Chung WY, Hong SW, Hong SJ, Lee JH, Yi KH, Jo YS, Kang HC, Shong M, Park JW, Yoon JH, Kang SJ, Lee KW. Management Guidelines for Patients with Thyroid Nodules and Thyroid Cancer. ACTA ACUST UNITED AC 2007. [DOI: 10.3803/jkes.2007.22.3.157] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Won Bae Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Korea
| | - Tae Yong Kim
- Department of Internal Medicine, University of Ulsan College of Medicine, Korea
| | - Hyuk Sang Kwon
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
| | - Won-Jin Moon
- Department of Radiology, Konkuk University School of Medicine, Korea
| | - Jae Bok Lee
- Department of Surgery, Korea University College of Medicine, Korea
| | - Young Sik Choi
- Department of Internal Medicine, Kosin University College of Medicine, Korea
| | | | | | | | - Jung Hwan Baek
- Department of Radiology, Daerim St. Mary's Hospital, Korea
| | | | - Do Joon Park
- Department of Internal Medicine, Seoul National University School of Medicine, Korea
| | - Dong Gyu Na
- Department of Radiology, Seoul National University School of Medicine, Korea
| | - Jun Ho Choe
- Department of Surgery, Seoul National University School of Medicine, Korea
| | - Jae Hoon Chung
- Department of Medicine, Sungkyunkwan University School of Medicine, Korea
| | - Hye Seung Jung
- Department of Medicine, Sungkyunkwan University School of Medicine, Korea
| | - Jeong Han Kim
- Department of Surgery, Sungkyunkwan University School of Medicine, Korea
| | - Kee Hyun Nam
- Department of Surgery, Yonsei University College of Medicine, Korea
| | - Hang-Seok Chang
- Department of Surgery, Yonsei University College of Medicine, Korea
| | - Woong Youn Chung
- Department of Surgery, Yonsei University College of Medicine, Korea
| | - Soon Won Hong
- Department of Pathology, Yonsei University College of Medicine, Korea
| | - Suck Joon Hong
- Department of Surgery, University of Ulsan College of Medicine, Korea
| | - Jeong Hyun Lee
- Department of Radiology, University of Ulsan College of Medicine, Korea
| | - Ka Hee Yi
- Department of Internal Medicine, Korea Cancer Center Hospital, Korea
| | - Young Suk Jo
- Department of Internal Medicine, School of Medicine, Eulji University, Korea
| | - Ho-Cheol Kang
- Department of Internal Medicine, Chonnam National University Medical School, Korea
| | - Minho Shong
- Department of Internal Medicine, Chungnam National University College of Medicine, Korea
| | - Jin Woo Park
- Department of Surgery, Chungbuk National University College of Medicine, Korea
| | - Jong Ho Yoon
- Department of Surgery, Hallym University College of Medicine, Korea
| | - Seong Joon Kang
- Department of Surgery, Yonsei University Wonju College of Medicine, Korea
| | - Kwang Woo Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Korea
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Chiang FY, Lin JC, Lee KW, Wang LF, Tsai KB, Wu CW, Lu SP, Kuo WR. Thyroid tumors with preoperative recurrent laryngeal nerve palsy: Clinicopathologic features and treatment outcome. Surgery 2006; 140:413-7. [PMID: 16934603 DOI: 10.1016/j.surg.2006.02.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2005] [Revised: 02/23/2006] [Accepted: 02/25/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND The aim of this present study is to define the significance of recurrent laryngeal nerve palsy (RLNP) detected before surgery for thyroid diseases with regard to the incidence of malignancy, histopathologic distribution, extrathyroidal invasion, management, and prognosis. METHODS Six hundred and twenty-two patients underwent operation for various thyroid disease and were treated by the same surgeon. The study was confined to 16 (3%) patients who suffered from a thyroid tumor with preoperative RLNP. RESULTS Of these 16 patients, 1 had benign thyroid disease, while the other 15 had malignancy (94%). Among the 15 cancer patients, 14 had extrathyroidal invasion and needed more extensive surgical procedures than total thyroidectomy. The recurrent laryngeal nerve could be dissected from the thyroid neoplasm in 3 patients, 2 of whom experienced recovery of this nerve's function postoperatively. CONCLUSIONS Thyroid tumor associated with RLNP is strongly suggestive of malignancy. The RLN should be preserved if it has not been invaded by the tumor, because it offers a good chance of functional recovery postoperatively. Well-differentiated thyroid cancer accounts for only half of these patients who tend to present at an older age and feature a much higher incidence of upper aerodigestive tract invasion. The operations for these patients often are complex and should be performed by experienced surgeons. Radical excision of a resectable anaplastic or squamous cell carcinoma of the thyroid gland offers the chance, albeit small, of long-term survival in this study.
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Affiliation(s)
- Feng-Yu Chiang
- Department of Otolaryngology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
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Abstract
The necessity of a cervical tracheal replacement arises with thyroid carcinoma, which occasionally infiltrates the trachea extensively, the rare primary tracheal tumors and, sporadically, benign stenoses. In the present study, we used an uncoated porous polypropylene prosthesis as cervical tracheal replacement in sheep. Specifically, we implanted a tracheal prosthesis of polypropylene mesh as a cervical tracheal replacement in five sheep, protecting the airways with self-expanding stents. Healing-in of the prostheses was checked bronchoscopically. The animals were killed after increasing survival times (7, 28, 64, 68, and >90 days), and incorporation of the prosthesis was examined macroscopically, microangiographically and histologically. Although medium-term survival was possible with a sufficiently wide airway, all animals were ultimately euthanized because of complications (airway stenosis, prolapse of prosthesis). Nevertheless, the results show that replacement of the cervical trachea with a polypropylene mesh can be successful under different experimental conditions.
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Affiliation(s)
- Matthias Behrend
- Klinik für Viszeral-, Thorax-, Gefäss- und Kinderchirurgie, Klinikum Deggendorf, Germany.
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Cooper DS, Doherty GM, Haugen BR, Kloos RT, Lee SL, Mandel SJ, Mazzaferri EL, McIver B, Sherman SI, Tuttle RM. Management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2006; 16:109-42. [PMID: 16420177 DOI: 10.1089/thy.2006.16.109] [Citation(s) in RCA: 1288] [Impact Index Per Article: 71.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- David S Cooper
- Sinai Hospital of Baltimore and Johns Hopkins University School of Medicine, MD, USA
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Abstract
The incidence of epithelial derived thyroid cancer (papillary thyroid cancer and follicular thyroid cancer, known collectively as differentiated thyroid cancer) is rising. About 80% of patients with thyroid cancer have PTC and are best treated with thyroidectomy and functional lymph node dissection, followed by radioiodine ablation or therapy and performance of a posttreatment whole-body scan, followed by thyroid stimulating hormone (TSH) suppression. One year after radioiodine administration, the use of sensitive thyroglobulin (Tg) assays can separate the vast majority of patients with persistent disease from those who are free of disease and unlikely to have recurrent disease all without the need for repeat whole-body radioiodine imaging. Patients with detectable serum Tg during TSH suppression (Tg-on) or Tg that rises above 2 ng/mL after TSH stimulation (TSH-Tg) are highly likely to harbor residual tumor. TSH stimulation can be achieved using either thyroid hormone withdrawal or recombinant human TSH (rhTSH). Highly skilled screening neck ultrasonography can identify a few additional patients with subcentimeter residual neck lymph node metastases not detected by TSH-Tg. However, ultrasonography and chest computed tomography (CT) are most critical for tumor localization in those patients with Tg values that suggest residual disease or in those patients with persistent antithyroglobulin antibodies (TgAb) that falsely lower Tg measurement. TgAb quantitative titers typically resolve steadily over just a few years in patients free of disease after initial therapy. Another paradigm shift is the recognition that most patients who eventually achieve freedom from disease do so by surgery with fewer patients cured by repetitive radioiodine treatments, and even fewer cured with external beam radiation. Patients who appear to be free of disease require a lifetime of follow-up to optimize levothyroxine treatment, and they will undergo periodic stimulation testing because some will still manifest recurrent disease. Patients with persistent disease despite negative ultrasonography, chest CT, and whole-body radioiodine imaging may have a tumor identified by fluorodeoxyglucose positron emission tomography, optimally performed with combined TSH stimulation and image fusion with CT or magnetic resonance imaging. Patients with metastatic disease who are unresponsive to conventional treatment are encouraged to participate in increasingly available thyroid cancer-specific clinical trials using targeted experimental oral or intravenous chemotherapeutic agents to address this tumor that has historically proven resistant to conventional chemotherapeutic agents.
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Affiliation(s)
- Richard T Kloos
- The Ohio State University, 446 McCampbell Hall, 1581 Dodd Drive, Columbus, OH 43210-1296, 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
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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44
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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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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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46
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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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Hammoud ZT, Mathisen DJ. Surgical management of thyroid carcinoma invading the trachea. CHEST SURGERY CLINICS OF NORTH AMERICA 2003; 13:359-67. [PMID: 12755320 DOI: 10.1016/s1052-3359(03)00018-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Airway invasion by thyroid carcinoma is an uncommon but important clinical problem. The surgical management of airway invasion is somewhat controversial, with some studies suggesting that conservative shave procedures might be adequate; however, the standardization and safety of techniques of airway resection and reconstruction have made en bloc surgery a reasonable approach for the management of such carcinomas. Tracheal resection and reconstruction for thyroid carcinomas with airway invasion might provide long-lasting palliation and might even be curative in a significant number of patients suffering from this disease.
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Affiliation(s)
- Zane T Hammoud
- General Thoracic Surgery Unit, Massachusetts General Hospital, 32 Fruit Street, Blake 1570, Boston, MA 02114, USA
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Sywak M, Pasieka JL, McFadden S, Gelfand G, Terrell J, Dort J. Functional results and quality of life after tracheal resection for locally invasive thyroid cancer. Am J Surg 2003; 185:462-7. [PMID: 12727568 DOI: 10.1016/s0002-9610(03)00057-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Local invasion of the upper aerodigestive tract by thyroid cancer, although uncommon, is a serious cause of morbidity and mortality. The impact of aerodigestive tract resection on the functional status and quality of life of the patient has not previously been investigated. METHODS Patients with locally invasive thyroid cancer were included in a prospective surgical protocol. Swallowing function was assessed with barium swallow at 7 days and 1 month postoperatively. Postoperative quality of life (QOL) was measured using a validated head and neck QOL instrument. RESULTS Seven patients underwent airway resection for locally invasive recurrent thyroid cancer in the period 1999 to 2001. At 1 week postoperative 3 of 7 (43%) had no evidence of aspiration on barium swallow. At 4 weeks 6 of 7 (86%) had no aspiration. Postoperative QOL scores in the domains of eating function (85.2) and emotional status (78.6) were significantly better than those of a comparison group undergoing treatment for cancers of the oropharynx, P = 0.012 and P = 0.0077, respectively. CONCLUSIONS Tracheal resection for locally invasive thyroid cancer is associated with a return to full dietary intake within 4 weeks of surgery in most cases. Function and QOL after this type of surgery are acceptable.
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Affiliation(s)
- Mark Sywak
- Division of Surgical Oncology, Tom Baker Cancer Center and University of Calgary, Calgary, Alberta, Canada
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Abstract
Medullary thyroid cancer is a rare neoplasm that arises from the parafollicular C cells. It occurs in a sporadic form, or less commonly as a hereditary form, as part of multiple endocrine neoplasia syndromes types 2A and 2B. The RET proto-oncogene is currently the primary factor that is implicated in the hereditary forms of this neoplasm. The knowledge about the genetic makeup of the neoplasm impacts upon management as it allows for screening, early detection, and prophylactic treatment. Surgery is the main modality that offers a cure. This entails a total thyroidectomy and vigilant management and surveillance of the neck. Prognosis of patients with MTC is variable, but the more constant factors that affect it are the stage of disease and the age of the patient. The emerging molecular genetic understanding of this malignancy will provide the foundation for prognostic and therapeutic decision-making in the future. Interdisciplinary management by surgeons, endocrinologists, pathologists, radiotherapists, radiologists, and medical oncologists should be sought.
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Affiliation(s)
- Gary L Clayman
- Department of Head and Neck Surgery, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Box 0441, Houston, TX 77030, USA.
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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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