1
|
Noy R, Habashi N, Akrish S, Cohen J, Shkedy Y. Preoperative tracheostomy is associated with thyroid gland invasion and poorer prognosis in laryngectomized patients. Eur Arch Otorhinolaryngol 2024; 281:935-943. [PMID: 37880425 DOI: 10.1007/s00405-023-08302-4] [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: 06/17/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE Patients with laryngeal cancer may necessitate tracheostomy placement to alleviate compromised airways. However, the impact of tracheostomy on thyroid gland invasion and its implications for prognosis in individuals who further undergo total laryngectomy remains unclear. This study aimed to assess thyroid gland invasion rates and explore the 5-years disease-free and overall survival in laryngectomized patients stratified by preoperative tracheostomy. METHODS All patients who underwent total laryngectomy for laryngeal cancer between 2003 and 2023 at a tertiary referral center were retrospectively reviewed. Logistic univariable and multivariable regressions were performed to identify factors associated with thyroid gland invasion. Survival analyses were performed using the Kaplan-Meier estimator. RESULTS A total of 119 laryngectomized patients were included (mean age: 63 ± 10 years, range 35-89, 110 [92.4%] males); 27 (22.7%) underwent preoperative tracheostomy. In 16 (13.4%) patients, tumor cells were found within the thyroid gland. In a multivariable analysis, thyroid gland invasion was independently associated with preoperative tracheostomy (odds ratio [OR] 3.13, 95% confidence interval [CI] 2.45-6.19), pN2 + (OR 2.13, 95% CI 1.8-5.14), positive margins (OR 1.36, 95% CI 1.01-1.77), lower 5-year disease-free survival (38% vs. 57%, p = 0.01), and lower 5-year overall survival (40% vs. 56%, p = 0.03). CONCLUSION Preoperative tracheostomy is an independent predictive factor for thyroid gland invasion and has adverse oncological outcomes in laryngectomized patients. Conversely, the rates of thyroid gland invasion are low when tracheostomy was not performed beforehand.
Collapse
Affiliation(s)
- Roee Noy
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel.
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Nadeem Habashi
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Sharon Akrish
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Department of Pathology, Rambam Health Care Campus, Haifa, Israel
| | - Jacob Cohen
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Yotam Shkedy
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
2
|
Ganesan S, Raj AJ, GS D, Lakshmanan J, Raja K, Penubarthi LK, Alexander A, Ramesh A. Correlation of Preoperative Radiological Factors with Histological Involvement of Thyroid Gland in Laryngeal Carcinomas. Indian J Otolaryngol Head Neck Surg 2024; 76:886-893. [PMID: 38440602 PMCID: PMC10908890 DOI: 10.1007/s12070-023-04305-z] [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: 08/11/2023] [Accepted: 10/19/2023] [Indexed: 03/06/2024] Open
Abstract
Total laryngectomy is the primary treatment for locally advanced laryngeal carcinomas. However, routine thyroid removal (total or hemithyroidectomy) during this procedure is controversial, as the incidence of thyroid gland involvement varies and may lead to lifelong thyroid supplementation, increasing postoperative morbidity. The lack of a consensus on managing the thyroid gland in laryngeal carcinoma cases necessitates improved evaluation techniques, with radiology playing a crucial role in this aspect. Understanding the correlation between radiological factors and histopathological involvement of the thyroid gland can aid in formulating appropriate management strategies during total laryngectomy. To study the correlation of preoperative radiological factors with histopathological involvement of thyroid gland in laryngeal carcinomas. This was a retrospective study which included 57 patients who underwent total laryngectomy for squamous cell carcinoma of larynx. The pre-operative CT findings such as involvement of thyroid cartilage, cricoid cartilage, paraglottic space, anterior commissure, subglottis and thyroid gland along with transglottic extension of tumor were correlated with post-operative histopathological thyroid gland involvement. Cricoid cartilage erosion and thyroid gland involvement in CT scans individually exhibited positive likelihood ratios of 2.58 and 3.23, respectively, demonstrating a reasonable agreement with histopathological findings. The specificity of cricoid cartilage and thyroid gland involvement was also higher with values of 76.4% and 81%, respectively. Moreover, combining thyroid and cricoid cartilage erosion in CT scans as a predictive parameter for thyroid gland involvement resulted in a better likelihood ratio of 8.23 and a fair agreement with histopathological findings. We conclude that cricoid cartilage erosion and thyroid gland involvement in pre-operative CECT can be taken as a preoperative indicator for intraoperative decision on thyroidectomy.
Collapse
Affiliation(s)
- Sivaraman Ganesan
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Antony James Raj
- Department of Head and Neck Surgery, Tata Memorial Centre, Mumbai, India
| | - Dharanya GS
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jijitha Lakshmanan
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Kalaiarasi Raja
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Lokesh Kumar Penubarthi
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Arun Alexander
- Department of Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Ananthakrishnan Ramesh
- Department of Radiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| |
Collapse
|
3
|
Verro B, Lo Casto A, Saraniti C. Positive Delphian node in laryngeal cancer: Predictive of thyroid gland metastasis? Int J Surg Case Rep 2023; 110:108736. [PMID: 37659157 PMCID: PMC10509915 DOI: 10.1016/j.ijscr.2023.108736] [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: 07/16/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/04/2023] Open
Abstract
INTRODUCTION Laryngeal carcinoma represents the 22nd most common cancer worldwide. Thyroid metastasis from laryngeal cancer is extremely rare. Overall, thyroid gland involvement by metastatic carcinoma represents about 1.1-2.1 % among thyroid malignant diseases. PRESENTATION OF CASE A male in his 70s came to our Otolaryngology Unit with a laryngeal squamous cell carcinoma (cT3). Total laryngectomy and bilateral neck dissection were performed. Histological examination revealed a pT3 carcinoma with sub-massive metastasis of the Delphian node. The patient underwent close follow-up. After eight months, neck examination revealed a suspected nodule in the right thyroid lobe. A right thyroid lobectomy was performed, and histological assessment revealed a nodule with squamous carcinoma metastasis in the superior pole of the thyroid lobe. The remaining thyroid tissue was affected by multinodular macrofollicular goitre. The patient underwent adjuvant therapy. One year after the second surgery, he showed no signs of recurrence. DISCUSSION Thyroid gland metastasis from laryngeal carcinoma is a very rare occurrence. In literature, we found only three articles that describes thyroid metastasis in overall 7 patients affected by laryngeal squamous cell carcinoma. Positive Delphian lymph node is usually related to poor prognosis: in 2007 a study reported tumour recurrence in 15 out of 25 patients with metastatic Delphian lymph node within the first two years of surgery. CONCLUSION Thyroid gland metastasis from laryngeal carcinoma is rare; so close follow-up of oncologic patients is mandatory and, most of all, the positive Delphian node should not be underestimated for its predictive value.
Collapse
Affiliation(s)
- Barbara Verro
- Division of Otolaryngology, Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
| | - Antonio Lo Casto
- Division of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy
| | - Carmelo Saraniti
- Division of Otolaryngology, Department of Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, 90127 Palermo, Italy.
| |
Collapse
|
4
|
Obongo Anga R, Abbaci M, Guerlain J, Breuskin I, Casiraghi O, Marhic A, Benmoussa-Rebibo N, de Kermadec H, Moya-Plana A, Temam S, Gorphe P, Hartl DM. Intraoperative Autofluorescence Imaging for Parathyroid Gland Identification during Total Laryngectomy with Thyroidectomy. Cancers (Basel) 2023; 15:cancers15030875. [PMID: 36765832 PMCID: PMC9913419 DOI: 10.3390/cancers15030875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/08/2022] [Accepted: 01/28/2023] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Hypoparathyroidism is a known complication of total laryngectomy, although parathyroid preservation and/or reimplantation are not routine. Autofluorescence is a new technique for identifying parathyroid glands intraoperatively. The aim of this study was to evaluate the feasibility of autofluorescence in this context. MATERIALS AND METHODS A retrospective study of patients undergoing total laryngectomy/pharyngectomy with concomitant thyroidectomy using the Fluobeam® (Fluoptics, Grenoble, France) and frozen section of a parathyroid fragment in case of reimplantation. The rates of identification using autofluorescence, reimplantation, and hypoparathyroidism were evaluated. RESULTS Eighteen patients (16 males, median age 67) underwent total laryngectomy/pharyngectomy with total thyroidectomy (n = 12) or hemithyroidectomy (n = 6). A median of 2 parathyroid glands were identified per patient. Ninety-two percent were identified by autofluorescence before visualisation. All parathyroids were reimplanted due to devascularization. Temporary hypoparathyroidism occurred in nine patients, and was permanent in one patient. After 34 months of median follow-up (range 1-49), no tumor recurrence was observed in the reimplantation sites. CONCLUSIONS To our knowledge, this is the largest study to evaluate autofluorescence during total laryngectomy with thyroidectomy. No tumor recurrence occurred in the sites of parathyroid reimplantation.
Collapse
Affiliation(s)
- Raïs Obongo Anga
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
- Department of Head and Neck Cancer and ENT Surgery, Henri Becquerel Cancer Center, 76038 Rouen, France
| | - Muriel Abbaci
- Plateforme d’Imagerie et de Cytométrie, UMS AMMICa, Gustave-Roussy Cancer Campus—Grand Paris, Université Paris-Saclay, 94805 Villejuif, France; Laboratoire d’Imagerie Biomédicale Multimodale Paris Saclay, Université Paris-Saclay, CEA, CNRS, Inserm, 91401 Orsay, France
| | - Joanne Guerlain
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Ingrid Breuskin
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Odile Casiraghi
- Department of Pathology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Alix Marhic
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Nadia Benmoussa-Rebibo
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Héloïse de Kermadec
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Antoine Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Stéphane Temam
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Philippe Gorphe
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Dana M. Hartl
- Department of Head and Neck Oncology, Gustave Roussy Cancer Campus, 94805 Villejuif, France
- Correspondence:
| |
Collapse
|
5
|
Edafe O, Tan ET, Jackson R, Sionis S, Balasubramanian SP, Beasley N. Evaluation of hypoparathyroidism following laryngectomy. Ann R Coll Surg Engl 2023; 105:62-67. [PMID: 35132880 PMCID: PMC9773242 DOI: 10.1308/rcsann.2021.0276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Hypoparathyroidism is a recognised complication following laryngectomy; it is associated with significant short-and long-term morbidity. This study aimed to further characterise this condition, identify risk factors and describe preventative and management strategies in a large cohort. MATERIALS AND METHODS This was a retrospective study at a tertiary referral centre for head and neck cancers. All consecutive patients who had total laryngectomy over an eight-year period were included. RESULTS A total of 140 patients were included. Rates of transient and long-term hypoparathyroidism were 14.3% and 10.1%, respectively. The following factors were significantly associated with transient post-surgical hypocalcaemia or hypoparathyroidism: total thyroidectomy (relative risk, RR, 4.33; 95% confidence interval, CI, 1.86-10.10), oesophagectomy (RR 6.05; 95% CI 2.92-12.53) and female sex (RR 3.23; 95% CI 1.45-7.19). In addition, total thyroidectomy (RR 5.89; 95% CI 1.94-17.86), central neck dissection (RR 3.97; 95% CI 1.42-11.10), oesophagectomy (RR 9.38; 95% CI 4.13-21.3), pharyngectomy (RR 7.14; 95% CI 2.08-24.39) and female sex (RR 5.52; 95% CI 1.95-15.63) were risk factors for long-term hypoparathyroidism. There was variability in the use of preventative measures, monitoring and management of hypocalcaemia and hypoparathyroidism following total laryngectomy. CONCLUSIONS Transient hypocalcaemia and long-term hypoparathyroidism occur in a significant proportion of patients after laryngectomy. A standard protocol is required to improve care.
Collapse
Affiliation(s)
- O Edafe
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - ET Tan
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - R Jackson
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | - S Sionis
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| | | | - N Beasley
- Sheffield Teaching Hospitals NHS Foundation Trust, UK
| |
Collapse
|
6
|
Lu W, Zhu J. A commentary on "thyroid gland invasion in total laryngectomy: A systematic review and meta-analysis" (int J surg 2022;99:106,262). Int J Surg 2022; 102:106665. [PMID: 35589048 DOI: 10.1016/j.ijsu.2022.106665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/06/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Wei Lu
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610044, PR China
| | - Jingqiang Zhu
- Center of Thyroid & Parathyroid Surgery, West China Hospital, Sichuan University, Chengdu, 610044, PR China.
| |
Collapse
|
7
|
Xie J, Liu H, Wu P, Chen L, Ge P, Chen S, Zhang S, Lu Z. Predictors of Thyroid Gland Invasion in Total Laryngectomy for Advanced Laryngeal Squamous Cell Carcinoma. EAR, NOSE & THROAT JOURNAL 2022:1455613221098300. [PMID: 35533678 DOI: 10.1177/01455613221098300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: Thyroidectomy for advanced laryngeal squamous cell carcinoma (LSCC) is controversial. This study aimed to identify predictors of thyroid gland invasion in patients with LSCC and management of the thyroid gland during total laryngectomy. Patients and Methods: Clinical data and pathological characteristics of 113 patients, who underwent laryngectomy with thyroidectomy for advanced LSCC in Guangdong Provincial People's Hospital between 2009 and 2019, were retrospectively analyzed. The incidence and predictors of thyroid gland invasion were analyzed, and a new predictor was proposed using a parallel test. Results: Of 113 patients, 25.7% exhibited thyroid invasion. A new predictor that combined the lower third of thyroid cartilage invasion and thyroid gland invasion on computed tomography/magnetic resonance imaging (CT/MRI) was associated with pathological thyroid gland invasion (P = 0.001; sensitivity, 88.2%; negative predictive value, 95%). Conclusion: Thyroidectomy may be required during total laryngectomy in those with invasion of the lower third of thyroid cartilage and/or thyroid gland invasion revealed on CT/MRI instead of being performed routinely.
Collapse
Affiliation(s)
- Jiaxuan Xie
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- 66477Shantou University Medical College, Shantou, China
| | - Hui Liu
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- 66477Shantou University Medical College, Shantou, China
| | - Peiyan Wu
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Liangsi Chen
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Pingjiang Ge
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shaohua Chen
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Siyi Zhang
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhongming Lu
- Department of Otolaryngology-Head and Neck Surgery, 89346Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| |
Collapse
|
8
|
Xie J, Wu P, Liu H, Zhang S, Lu Z. Thyroid gland invasion in total laryngectomy: A systematic review and meta-analysis. Int J Surg 2022; 99:106262. [PMID: 35172203 DOI: 10.1016/j.ijsu.2022.106262] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 12/09/2021] [Accepted: 02/09/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Although guidelines indicate that thyroidectomy should be performed routinely during total laryngectomy in patients with advanced laryngeal cancer, its clinical indications remain controversial. Some researchers believe that thyroid invasion is uncommon and that thyroid preservation should be considered in most cases. OBJECTIVE This study aimed to identify the incidence and predictors of thyroid invasion in patients with laryngeal cancer to facilitate decision-making regarding whether to perform thyroidectomy during total laryngectomy. MATERIALS AND METHODS The author conducted a systematic review and meta-analysis of all published articles retrieved from a search of the MEDLINE (1982-2020) and EMBASE (1971-2020) databases. The published studies of advanced laryngeal cancer with total laryngectomy and partial or total thyroidectomy for laryngeal cancer were selected. The incidence and predictors of thyroid invasion were analyzed. RESULTS We analyzed 25 studies (2177 cases), of which 176 people (8.08%) had thyroid invasion. Subglottic tumors (odds ratio [OR], 3.74; 95% CI, 1.75-7.99), T4 stage tumors (OR, 2.39; 95% CI, 1.20-4.75), subglottic extension (OR, 3.85; 95% CI,2.09-7.11), and thyroid cartilage invasion (OR, 3.98; 95% CI, 1.47-10.75) are risk factors for thyroid invasion, and no statistically significant difference was noted between recurrent tumor and thyroid invasion. CONCLUSION The risk of thyroid invasion was significantly higher when advanced laryngeal cancer involved subglottic tumors, T4 stage tumors, subglottic extension, and thyroid cartilage invasion. The overall incidence of thyroid gland invasion was low; therefore, thyroidectomy may be performed for cases deemed risky rather than as a routine measure of total laryngectomy. RESEARCH REGISTRY UIN: reviewregistry1226.
Collapse
Affiliation(s)
- Jiaxuan Xie
- Department of Otolaryngology-Head and Neck Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China Shantou University Medical College, Shantou, Guangdong, China The Second School of Clinical Medicine, Southern Medical University, China
| | | | | | | | | |
Collapse
|
9
|
Pasha HA, Wasif M, Ikram M, Hammad M, Ghaloo SK, Rashid Z. Frequency of Thyroid Gland Invasion by Laryngeal Squamous Cell Carcinoma: The Role of Subglottic Extension. Int Arch Otorhinolaryngol 2022; 26:e574-e578. [PMID: 36405478 PMCID: PMC9668439 DOI: 10.1055/s-0041-1740200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/27/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction
Management of the thyroid gland during laryngectomy has been controversial. The primary tumor may invade the thyroid gland by direct invasion or lymphovascular spread. Hypothyroidism and hypoparathyroidism are potential risks when lobectomy or total thyroidectomy are performed simultaneously.
Objective
To report the frequency of thyroid gland involvement by primary laryngeal squamous cell carcinoma in patients undergoing laryngectomy and to identify possible risk factors for thyroid gland involvement so that judicious excision of thyroid gland can be attained.
Methods
We performed a retrospective review of 9 years. Data was collected from medical records of patients dated from December 2009 to October 2018. All patients with laryngeal cancer who underwent laryngectomy with lobectomy or total thyroidectomy were included in the present study.
Results
We reviewed 151 laryngectomy records. A total of 130 surgeries included the thyroid gland with the excised specimen and were available for analysis. There were 124 males and 6 females. The mean age was 59.4 years old. The glottis was the most common subsite involved, in 70 patients, followed by 38 transglottic, 16 supraglottic and 03 subglottic tumors. On histology, 12 out of 130 excised thyroid glands were involved by squamous cell carcinoma. Only subglottic involvement (
p
= 0.01) was significantly associated with thyroid gland invasion (TGI). Type of laryngectomy, subsite of the primary tumor, thyroid cartilage involvement, neck nodal metastases, and perineural and lymphatic invasion by the primary tumor were not associated with TGI.
Conclusion
Only subglottic involvement is associated with TGI; therefore, preoperative and intraoperative assessment is necessary prior to considering excision of the thyroid gland.
Collapse
Affiliation(s)
- Hamdan Ahmed Pasha
- Department of Otolaryngology and Head and Neck Surgery, Jinnah Medical and Dental College, Karachi, Pakistan
| | - Muhammad Wasif
- Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Mubasher Ikram
- Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Hammad
- Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Shayan Khalid Ghaloo
- Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Zafar Rashid
- Department of Otolaryngology and Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
10
|
El-Sebai Ali M, Atef Ebada H, El-Shaheed MA, Musaad AbdElFattah A, Kamal ELS. Routine thyroidectomy with total laryngectomy: Is it really indicated? A randomized controlled trial. Ann Med Surg (Lond) 2022; 74:103309. [PMID: 35145675 PMCID: PMC8818527 DOI: 10.1016/j.amsu.2022.103309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/08/2022] [Accepted: 01/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background We investigated the incidence of thyroid gland invasion in patients with advanced laryngeal carcinoma who were treated with total laryngectomy, also the impact of different preoperative and intraoperative predictors on thyroid gland invasion. Moreover, the impact of thyroid gland preservation on the locoregional tumor control and the recurrence rates after surgery were investigated. Materials and methods This study was conducted over 5 years on 100 patients with advanced laryngeal carcinoma who underwent total laryngectomy. The adopted protocol in our hospital is to perform an ipsilateral thyroid lobectomy if there is subglottic extension, thyroid or cricoid cartilage invasion or true invasion of the thyroid gland. The patients of the study were divided into thyroid sparing and thyroid sacrificing groups. The two groups were compared in terms of demographic data, tumor characteristics, incidence of postoperative hypothyroidism and tumor recurrence. Results There was no significant difference between groups regarding the tumor profile. Regarding local tumor spread, the only two subsites that showed significant difference is anterior commissure and thyroid cartilage invasion. In the thyroid sacrificing group, invasion of the thyroid gland was proved histopathologically in only one patient. Postoperatively, the incidence of hypothyroidism was significantly higher in the thyroid sacrificing group. However, there was no statistically significant difference between the two groups regarding the incidence of tumor recurrence. Conclusion The incidence of thyroid gland invasion by an advanced laryngeal carcinoma is low. Preservation of the thyroid gland during laryngectomy to reduce the risk of thyroid dysfunction does not affect the oncological control. Thyroid gland invasion incidence in advanced laryngeal carcinoma is low. Thyroid gland Preservation during laryngectomy does not affect the oncological control. There was no statistically significant difference between the thyroid sparing and thyroid sacrificing group regarding the incidence of recurrence. Due toding author”. Due toding author".
Collapse
|
11
|
de Vincentiis M, Greco A, Campo F, Candelori F, Ralli M, Di Traglia M, Colizza A, Cambria F, Zocchi J, Manciocco V, Spriano G, Pellini R. Open partial horizontal laryngectomy for T2-T3-T4a laryngeal cancer: oncological outcomes and prognostic factors of two Italian hospitals. Eur Arch Otorhinolaryngol 2022; 279:2997-3004. [PMID: 34978589 DOI: 10.1007/s00405-021-07238-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 12/22/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE The purpose of this study was to analyse the oncologic results of open partial horizontal laryngectomy (OPHL) and to assess the prognostic factors that could affect the survival of patients affected by T2, T3 and T4a laryngeal cancer. Using this data, we aim to identify clinical criteria to select patients amenable to conservative surgery, and to facilitate a more targeted approach in the management of advanced laryngeal cancer. METHODS A retrospective study was performed in patients who underwent OPHL type II for laryngeal squamous cell carcinoma from January 2005 to December 2018. We analysed a total of 170 patients; 21(12.36%) cases were staged as pT2, 116 (68.23%) as pT3 and 33 (19.41%) as pT4a. RESULTS Five-year overall survival (OS) was 80.9%, 79.3%, 70.4% for T2, T3 and T4 respectively. Disease-specific survival (DSS) was 90.4%, 85.3% and 77.4%. Posterior tumour extension, perineural invasion and N status showed to considerably influence survival in both uni- and multivariate analyses. CONCLUSION The oncological outcomes from our study show that OPHL for advanced laryngeal cancer can guarantee a high percentage of success. Accurate patient selection is of utmost importance to differentiate advanced disease amenable to conservative surgery, and treatment options should consider selected criteria based on tumour and patient features.
Collapse
Affiliation(s)
- Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Flaminia Campo
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.,Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesca Candelori
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Mario Di Traglia
- Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy
| | - Andrea Colizza
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy.
| | - Francesca Cambria
- Department of Sense Organs, Sapienza University of Rome, Viale del Policlinico 155, 00186, Rome, Italy
| | - Jacopo Zocchi
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Valentina Manciocco
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Spriano
- Otorhinolaryngology Unit, Humanitas Clinical and Research Center-IRCCS, Rozzano, Milan, Italy
| | - Raul Pellini
- Department of Otolaryngology-Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| |
Collapse
|
12
|
Aslıer M, Uçurum BE, Kaya HC, Coskun H. The prognostic value of thyroid gland invasion in locally advanced laryngeal cancers. Acta Otolaryngol 2021; 141:865-872. [PMID: 34406113 DOI: 10.1080/00016489.2021.1962013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Locally advanced laryngeal cancers can spread to the thyroid gland by direct invasion of cricothyroid membrane. The prevalence of thyroid gland invasion (TGI) and the predictive factors of TGI were well described in literature. However, the association of TGI with survival was undetermined yet. OBJECTIVES The aim of this study is to analyze the effects of TGI on survival rates in patients with locally advanced laryngeal cancer. MATERIALS AND METHODS Medical records of 91 patients who underwent total laryngectomy with thyroidectomy were retrospectively reviewed. Demographical, clinical, and histopathological characteristics of the patients were noted. Kaplan-Meier test was used for survival analysis. RESULTS Histopathology reports revealed the prevalence of TGI as 14.3% (13/91). Survival analyses showed that TGI did not affect recurrence free (p = .078) and overall (p = .080) survival rates. CONCLUSIONS Thyroid gland invasion is one of the characteristic features of locally aggressive laryngeal tumors. In this study, TGI is not a statistically significant prognostic factor that has impact on survival of the patients with locally advanced laryngeal cancer.
Collapse
Affiliation(s)
- Mustafa Aslıer
- Department of Otolaryngology – Head and Neck Surgery, Bursa Uludağ University School of Medicine, Bursa, Turkey
| | - Bahar Ezgi Uçurum
- Department of Otolaryngology – Head and Neck Surgery, Bursa Uludağ University School of Medicine, Bursa, Turkey
| | - Hilmi Cem Kaya
- Department of Otolaryngology – Head and Neck Surgery, Bursa Uludağ University School of Medicine, Bursa, Turkey
| | - Hakan Coskun
- Department of Otolaryngology – Head and Neck Surgery, Bursa Uludağ University School of Medicine, Bursa, Turkey
| |
Collapse
|
13
|
Brunet A, Tornari C, Ezebuiro A, Kennedy R, Connor SEJ, Oakley R, Jeannon JP, Arora A, Rovira A, Simo R. Role of Thyroidectomy in Recurrent Laryngeal Carcinoma. Otolaryngol Head Neck Surg 2021; 166:894-900. [PMID: 34403272 DOI: 10.1177/01945998211033523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Management of recurrent laryngeal cancer presents a major challenge, and salvage laryngectomy is complicated by previous oncologic treatments. Thyroidectomy as part of salvage laryngectomy adds a nonnegligible degree of morbidity. The purpose of this study is to assess the rate of thyroid gland invasion in patients undergoing salvage laryngectomy to determine relevant predictive factors. STUDY DESIGN Case series with chart review. SETTING Department of Otorhinolaryngology, Head and Neck Surgery, Guy's Hospital, London, United Kingdom. METHODS A retrospective review of patients undergoing salvage laryngectomy between 2009 and 2019 was undertaken. Preoperative cross-sectional imaging and histopathological analysis were performed to define evidence and predictors of thyroid gland invasion (TGI). RESULTS Fifty-one patients had salvage laryngectomy. Histological evidence of TGI was found in 4 patients (7.8%). No significant relationship was found between histological TGI and subsite of primary carcinoma, degree of differentiation, T staging, or radiological TGI. Preoperative computed tomography had a high negative predictive value for TGI. CONCLUSION Thyroidectomy should be carefully considered in patients undergoing salvage laryngectomy, and its extent should be defined on an individual basis. Total thyroidectomy should not routinely be performed in salvage laryngectomy or pharyngolaryngectomy in patients with no preoperative radiological evidence of TGI on cross-sectional imaging, unless there is intraoperative evidence of TGI.
Collapse
Affiliation(s)
- Aina Brunet
- Department of Otorhinolaryngology, Head & Neck Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Chrysostomos Tornari
- Department of Otorhinolaryngology, Head & Neck Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Akunnah Ezebuiro
- Department of Otorhinolaryngology, Head & Neck Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Robert Kennedy
- Department of Oral Pathology, Academic Clinical Lecturer in Oral and Maxillofacial Pathology, King's College London, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Steve E J Connor
- School of Biomedical Engineering & Imaging Sciences Clinical Academic Group, King's College London, London UK.,Department of Radiology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Richard Oakley
- Department of Otorhinolaryngology, Head & Neck Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Jean-Pierre Jeannon
- Department of Otorhinolaryngology, Head & Neck Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Asit Arora
- Department of Otorhinolaryngology, Head & Neck Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Aleix Rovira
- Department of Otorhinolaryngology, Head & Neck Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| | - Ricard Simo
- Department of Otorhinolaryngology, Head & Neck Surgery, Guy's and St Thomas' Hospitals NHS Trust, London, UK
| |
Collapse
|
14
|
Does thyroid-sparing total laryngectomy decrease the risk of hypothyroidism? The Journal of Laryngology & Otology 2020; 134:1069-1072. [PMID: 33243316 DOI: 10.1017/s0022215120002479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Thyroid lobectomy is recommended with total laryngectomy for laryngeal cancer in the National Comprehensive Cancer Network ('NCCN') guidelines. However, it is associated with a 32-89 per cent risk of hypothyroidism, with or without adjuvant radiotherapy. OBJECTIVE The study aimed to determine whether preserving the whole thyroid, compared to a single lobe, does indeed significantly lower the incidence of hypothyroidism in the setting of total laryngectomy. METHOD A retrospective study was conducted at Groote Schuur Hospital in Cape Town, South Africa. RESULTS Eighty-four patients met the inclusion criteria. The overall incidence of hypothyroidism was 45.2 per cent. The incidence of hypothyroidism was significantly reduced in patients who underwent thyroid-sparing total laryngectomy compared to hemithyroidectomy (p = 0.037). Adjuvant radiotherapy was associated with a higher incidence of hypothyroidism (p = 0.001). CONCLUSION Thyroid-preserving laryngectomy should be advocated in carefully selected patients with advanced laryngeal carcinoma, as it reduces the incidence of hypothyroidism.
Collapse
|
15
|
Muhammad T, Dhanani R, Mohtasham S, Hussain M, Faisal M, Malik KI, Jamshed A, Hussain R. Incidence of thyroid gland invasion in advanced laryngeal cancers and its impact on disease-specific survival; a retrospective review at a tertiary care center. Acta Otolaryngol 2020; 140:882-885. [PMID: 32633590 DOI: 10.1080/00016489.2020.1778786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Background: Incidence of thyroid gland invasion in advanced laryngeal cancers is low. Ipsilateral or total thyroidectomy along with total laryngectomy has been controversial and there has been no consensus over the management of thyroid gland in advanced laryngeal cancers.Objective: To determine the frequency of thyroid gland invasion in locally advanced laryngeal squamous cell carcinoma and the risk factors associated with it.Material and methods: A retrospective review of patients with laryngeal squamous cell carcinoma operated at our center between January 2011 and December 2018 was carried out. Patients undergoing upfront or salvage laryngectomy with or without neck dissection along with hemi or total thyroidectomy were included. Histopathology reports were reviewed to record the involvement of thyroid gland.Results: Invasion of thyroid gland by squamous cell carcinoma larynx was seen in 10 (10.9%) patients out of 92. All of the cases showed direct extension of the tumor. Trans-glottic, subglottic, and tumors with extra laryngeal spread were found to be significantly associated with thyroid gland invasion. Patients with thyroid gland invasion showed higher rate recurrence.Conclusion and significance: Incidence of thyroid gland invasion in squamous cell carcinoma larynx is low, allowing us not to address thyroid routinely in patients undergoing total laryngectomy for laryngeal carcinoma.
Collapse
Affiliation(s)
- Tahir Muhammad
- Department of Otolaryngology/Head & Neck Surgery, Peshawar Medical College & Kuwait Teaching hospital, Peshawar, Pakistan
| | - Rahim Dhanani
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Sameen Mohtasham
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Muntazir Hussain
- Department of Surgery, Cancer Foundation Hospital, Karachi, Pakistan
| | - Muhammad Faisal
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Kashif Iqbal Malik
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Arif Jamshed
- Department of Radiation Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| | - Raza Hussain
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| |
Collapse
|
16
|
Baghel SS, Singhal P, Verma N, Sehra R, Yadav R, Agarwal S, Sharma MP, Gupta DP. Is thyroid excision mandatory with laryngectomy in carcinoma larynx? BMC Cancer 2020; 20:700. [PMID: 32723304 PMCID: PMC7389649 DOI: 10.1186/s12885-020-07205-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 07/22/2020] [Indexed: 11/30/2022] Open
Abstract
Background Advanced stage operable cancers of larynx are treated with total laryngectomy including thyroid resection in most of the cases, which may expose patient to hypothyroidism and hypoparathyroidism. The requirement of thyroidectomy during Total Laryngectomy is controversial. Methods A cross sectional observational study was set out to review preoperative clinical and radiological assessment; intraoperative and histopathological findings; and follow-up data to predict thyroid gland invasion in the setting of squamous cell carcinoma of the Larynx. Results 11 (16%) out of 69 patients had thyroid gland involvement on histopathological examination with mean age 63 years. Out of these 11 cases, 8 (72%) underwent primary total laryngectomy. 90% patients with thyroid gland involvement were male. 9 cases with thyroid gland involvement were staged as T4a preoperatively. Conclusion Invasion of thyroid gland by laryngeal cancer is uncommon. Unnecessary hemithyroidectomies lead to hypothyroidism and hypoparathyroidism. The study points out the clear indications of thyroid excision in patients undergoing total laryngectomy. We can suggest that total thyroidectomy should be done with total laryngectomy in cases which have gross clinical, radiological or intraoperative thyroid gland involvement, subglottic extension and thyroid cartilage invasion. This can save the patients from the brunt of unnecessary morbid hypothyroidism and hypoparathyroidism.
Collapse
Affiliation(s)
- Surendra Singh Baghel
- Department of Neuro-otology, Sanjay Gandhi Post Graduate Institute, Lucknow, Uttar Pradesh, India
| | - Pawan Singhal
- Department of ENT, SMS Medical College, Jaipur, 302004, Rajasthan, India.
| | - Namita Verma
- Department of ENT, SMS Medical College, Jaipur, 302004, Rajasthan, India
| | - Ritu Sehra
- Department of ENT, SMS Medical College, Jaipur, 302004, Rajasthan, India
| | - Rajeev Yadav
- Department of Preventive and Social Medicine, Department of Otorhinolaryngology, SMS Medical College, Jaipur, Rajasthan, India
| | - Sunita Agarwal
- Department of ENT, SMS Medical College, Jaipur, 302004, Rajasthan, India
| | - Man Prakash Sharma
- Department of ENT, SMS Medical College, Jaipur, 302004, Rajasthan, India
| | - D P Gupta
- Department of ENT, SMS Medical College, Jaipur, 302004, Rajasthan, India
| |
Collapse
|
17
|
Does Thyroid Gland Preserving Total Laryngectomy Affect Oncological Control in Laryngeal Carcinoma? Laryngoscope 2019; 130:1465-1469. [DOI: 10.1002/lary.28235] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/27/2019] [Accepted: 07/23/2019] [Indexed: 11/07/2022]
|
18
|
Panda S, Kumar R, Konkimalla A, Thakar A, Singh CA, Sikka K, Sharma SC, Kakkar A, Bhasker S. Rationale behind thyroidectomy in total laryngectomy: analysis of endocrine insufficiency and oncological outcomes. Indian J Surg Oncol 2019; 10:608-613. [PMID: 31857751 DOI: 10.1007/s13193-019-00935-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022] Open
Abstract
Thyroidectomy conventionally accompanies total laryngectomy. This study intends to analyze the incidence and factors leading to thyroid gland involvement in carcinoma larynx and hypopharynx. Retrospective chart review from March 2011 to December 2016 of all patients who had undergone total laryngectomy at our institute. A total of 125 patients entered into the analysis. Subsites involved were glottis (n = 32), supraglottis (n = 28), transglottis (n = 52), pyriform sinus (n = 12), and subglottis (n = 1). TNM distribution according to AJCC 7th edition is as follows: T2 (n = 1), T3 (n = 34), T4 (n = 90); N0 (n = 97), N1 (n = 13), N2a (n = 5), N2b (n = 5), N2c (n = 4), and N3 (n = 1). Total thyroidectomy was performed in 16 patients, near total thyroidectomy in 5, and hemithyroidectomy in 104. Histopathologically thyroid gland involvement was seen in 11/125 (8.8%). The overall incidence of hypothyroidism was 48% (hemithyroidectomy, 43/104; total thyroidectomy, 16/16; near total thyroidectomy, 1/5). The incidence of permanent hypoparathyroidism was 12.8% (total thyroidectomy, 11; hemithyroidectomy, 5). On multivariate analysis (Cox proportional hazards model), extralaryngeal spread into level 6 (HR = 5.5, p = .006, C.I = 1-18.8) and extracapsular extension (HR = 9.3, p = 0.02, C.I = 1.29-67.5) were statistically significant predictors for thyroid gland involvement. Survival analysis of patients with thyroid gland involvement (n = 11) revealed 5-year overall survival (OS) of 100% and 5-year disease-free survival (DFS) of 59.3% compared with patients without thyroid gland involvement, 71% and 51.7%, respectively (median follow-up, 30 months). Thyroid gland involvement did not show a statistically significant effect on OS/DFS on multivariate analysis. In view of the endocrine abnormalities and lack of survival benefit seen, thyroidectomy should be performed judiciously during total laryngectomy.
Collapse
Affiliation(s)
- Smriti Panda
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, New Delhi, 110029 India
| | - Rajeev Kumar
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, New Delhi, 110029 India
| | - Abhilash Konkimalla
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, New Delhi, 110029 India
| | - Alok Thakar
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, New Delhi, 110029 India
| | - Chirom Amit Singh
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, New Delhi, 110029 India
| | - Kapil Sikka
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, New Delhi, 110029 India
| | - Suresh C Sharma
- 1Department of Otolaryngology and Head and Neck Surgery, All India Institute of Medical Sciences, Teaching Block, 4th Floor, New Delhi, 110029 India
| | - Aanchal Kakkar
- 2Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Suman Bhasker
- 3Department of Radiotherapy, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
19
|
Tomioka T, Beppu T, Fujii T, Ozawa T, Asakage T, Onitsuka T, Fujimoto Y, Matsuura K, Kawabata K, Hayashi R. Surgical management around the paratracheal area of hypopharyngeal cancer. Jpn J Clin Oncol 2019; 49:452-457. [PMID: 30811540 DOI: 10.1093/jjco/hyz019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/28/2018] [Accepted: 01/30/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We aimed to clarify the suitable surgical management around the paratracheal area of patients who undergo total pharyngolaryngectomy based on the pathological results of hypopharyngeal cancer. METHODS The study was conducted under a multicenter, retrospective observational design in Japan. We analyzed histopathological paratracheal lymph node metastasis and thyroid invasion, and recurrence around the paratracheal area for 184 patients who underwent initial surgery among 280 participants. RESULTS There were significant differences in the frequency of metastasis to paratracheal lymph nodes as cN advances (P = 0.0344) and cT advances (P = 0.00028). By subsite, the paratracheal lymph node metastasis ratio was 22/130 patients (16.9%) in piriform sinus (PS), 8/32 (25.0%) in PW, 5/22 (22.7%) in PC and 10/17 (58.8%) in cervical esophagus (Ce+). The ratio of cases with bilateral paratracheal metastasis tended to be higher in cN2c, posterior wall (PW) and postcricoid (PC). Invasion to the thyroid was histopathologically confirmed in 16/184 patients (8.7%). Invasion from the primary lesion was in 15 patients. CONCLUSION This study indicates that it is better for patients with advanced hypopharyngeal cancer at minimum undergo ipsilateral paratracheal lymph node dissection. Tumor subsite of PW, PC or cN2c disease or disease extending to the Ce+ should be treated with bilateral paratracheal neck dissection. In order to more reliably perform paratracheal dissection, there is also an option to resect the thyroid lobe in the range of dissection. Preservation of the thyroid gland can be considered if invasion into the thyroid gland has been clearly ruled out.
Collapse
Affiliation(s)
- Toshifumi Tomioka
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Takeshi Beppu
- Department of Head and Neck Surgery, Saitama Cancer Center Hospital, Kitaadachi, Japan
| | - Takashi Fujii
- Department of Head and Neck Surgery, Oosaka Medical Center for Cancer and Cardiovascular Diseases, Oosaka, Japan
| | - Taijirou Ozawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takahiro Asakage
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Tokyo Hospital, Bunkyou, Japan
| | - Tetsuro Onitsuka
- Department of Head and Neck Surgery, Shizuoka Cancer Center Hospital, Sunto, Japan
| | - Yasushi Fujimoto
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Nagoya Hospital, Nagoya, Japan
| | - Kazuto Matsuura
- Department of Head and Neck Surgery, Miyagi Cancer Center Hospital, Natori, Japan
| | - Kazuyoshi Kawabata
- Department of Head and Neck Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koutou, Japan
| | - Ryuichi Hayashi
- Department of Head and Neck Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| |
Collapse
|
20
|
Hypocalcaemia following laryngectomy: prevalence and risk factors. The Journal of Laryngology & Otology 2018; 132:969-973. [PMID: 30305187 DOI: 10.1017/s0022215118001615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To establish the prevalence of hypocalcaemia following laryngectomy and demonstrate that total thyroidectomy is a risk factor. METHODS A retrospective cohort study was conducted that included all patients who underwent total laryngectomy from 1st January 2006 to 1st August 2017. Exclusion criteria were: pre-operative calcium derangement, previous thyroid or parathyroid surgery, concurrent glossectomy, pharyngectomy, or oesophagectomy. RESULTS Ninety patients were included. Sixteen patients had early hypocalcaemia (18 per cent), seven had protracted hypocalcaemia (8 per cent) and six had permanent hypocalcaemia (10 per cent). Exact logistic regression values for hypocalcaemia following total thyroidectomy compared to other patients were: early hypocalcaemia, odds ratio = 15.5 (95 per cent confidence interval = 2.2-181.9; model p = 0.002); protracted hypocalcaemia, odds ratio = 13.3 (95 per cent confidence interval = 1.5-117.1; model p = 0.01); and permanent hypocalcaemia, odds ratio = 22.7 (95 per cent confidence interval = 1.9-376.5; model p = 0.005). CONCLUSION This is the largest study to investigate the prevalence of hypocalcaemia following laryngectomy and the first to include follow up of longer than three months. Total thyroidectomy significantly increased the risk of hypocalcaemia at all time frames and independent of other variables.
Collapse
|
21
|
Horwich P, Rigby MH, MacKay C, Melong J, Williams B, Bullock M, Hart R, Trites J, Taylor SM. Laryngeal recurrence sites in patients previously treated with transoral laser microsurgery for squamous cell carcinoma. J Otolaryngol Head Neck Surg 2018; 47:14. [PMID: 29433567 PMCID: PMC5810005 DOI: 10.1186/s40463-018-0266-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 02/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The laryngeal framework provides a natural barrier preventing tumour spread to extralaryngeal structures. Transoral laser microsurgery (TLM) for laryngeal squamous cell carcinoma (SCC) may violate these boundaries, altering the pathways of tumor spread for potential recurrences. Our project objective is to describe laryngeal SCC recurrence patterns and overall survival in patients requiring total laryngectomy (TL) after TLM. METHODS Patients undergoing TLM for laryngeal SCC requiring salvage TL were identified from a prospective CO2 laser database containing all patients undergoing TLM for head and neck malignancies at the QEII Health Sciences Center in Halifax, Nova Scotia between March 2002 - May 2014. Surgical pathology reports were analyzed for tumor characteristics, extent of recurrence and invasion of local structures. Kaplan-Meier analyses were performed to evaluate overall survival, disease specific survival (DSS) and locoregional control. RESULTS Fifteen patients were identified from the database as receiving salvage TL for recurrent disease after initial TLM resection for laryngeal SCC. Final pathology reports demonstrated that 67% (10/15) of patients had thyroid cartilage involvement while 53% (9/15) of patients had cricoid cartilage involvement on salvage TL pathology. 33% (5/15) of patients had perineural invasion and 27% (4/15) had lymphovascular invasion. Mean and median follow-up times were 36.7 months and 26.8 months respectively (range 3.9-112.6). The Kaplan-Meier estimate for overall survival at 36 months was 40% post TL with a standard error (SE) of 13.6%. DSS was 47% (SE 14.2%), and locoregional control was 55% (SE 14.5%) post TL. CONCLUSIONS Laryngeal recurrence sites following TLM seem to be consistent with historical data at known laryngeal sites of vulnerability. Treatment with TLM does not predispose patients to a lower rate of locoregional control and overall survival after total laryngectomy and salvage outcomes are consistent with literature values.
Collapse
Affiliation(s)
- P Horwich
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, 3rd Floor Dickson Building, VG Site, 5820 University Avenue, Halifax, NS, B3H 2Y9, Canada.
| | - M H Rigby
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, 3rd Floor Dickson Building, VG Site, 5820 University Avenue, Halifax, NS, B3H 2Y9, Canada
| | - C MacKay
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, 3rd Floor Dickson Building, VG Site, 5820 University Avenue, Halifax, NS, B3H 2Y9, Canada
| | - J Melong
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, 3rd Floor Dickson Building, VG Site, 5820 University Avenue, Halifax, NS, B3H 2Y9, Canada
| | - B Williams
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, 3rd Floor Dickson Building, VG Site, 5820 University Avenue, Halifax, NS, B3H 2Y9, Canada
| | - M Bullock
- Department of Pathology, Division of Anatomical Pathology, Queen Elizabeth II Health Science Centre and Dalhousie University, Halifax, NS, Canada
| | - R Hart
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, 3rd Floor Dickson Building, VG Site, 5820 University Avenue, Halifax, NS, B3H 2Y9, Canada
| | - J Trites
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, 3rd Floor Dickson Building, VG Site, 5820 University Avenue, Halifax, NS, B3H 2Y9, Canada
| | - S M Taylor
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, Queen Elizabeth II Health Science Centre and Dalhousie University, 3rd Floor Dickson Building, VG Site, 5820 University Avenue, Halifax, NS, B3H 2Y9, Canada
| |
Collapse
|
22
|
Harris AS, Passant CD, Ingrams DR. How reliably can computed tomography predict thyroid invasion prior to laryngectomy? Laryngoscope 2017; 128:1099-1102. [PMID: 28988411 DOI: 10.1002/lary.26927] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 08/07/2017] [Accepted: 08/23/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS There is little evidence to support the removal of thyroid tissue during total laryngectomy. Although oncological control of the tumor is the priority, thyroidectomy can lead to hypothyroidism and hypoparathyroidism. This study aimed to test the usefulness of preoperative computed tomography in predicting histological invasion of the thyroid. STUDY DESIGN Ambispective cohort study. METHODS All patients undergoing total laryngectomy for squamous cell carcinoma at one center from 2006 to 2016 were included. Data were recorded prospectively as part of the patients' standard care, but were collated retrospectively, giving this study an ambispective design. The histology report for thyroid invasion was taken as the gold standard. The computed tomography report was categorized by invasion of tumor into intralaryngeal, laryngeal cartilage involvement, and extralaryngeal tissues. RESULTS Seventy-nine patients were included. Nine patients had thyroid involvement on histology, translating to an incidence of 11.29% in this population. The positive predictive value for cartilage involvement on computed tomography for thyroid invasion was 52.9% (95% confidence interval [CI]: 28.5%-76.1%) and the negative predictive value was 100% (95% CI: 92.7%-100%).The positive predictive value for extralaryngeal spread on computed tomography for thyroid involvement was 100% (95% CI: 62.9%-100%), and the negative predictive value was also 100% (95% CI: 93.5%-100%). CONCLUSIONS This study has shown that preoperative computed tomography is an effective method of ruling out thyroid gland invasion. The absence of extralaryngeal spread on computed tomography has been shown to be the most useful finding, with a high negative predictive value and a narrow 95% CI. LEVEL OF EVIDENCE 4. Laryngoscope, 128:1099-1102, 2018.
Collapse
Affiliation(s)
- Andrew S Harris
- Department of Otorhinolaryngology Head and Neck Surgery, Aneurin Bevan University Health Board, The Royal Gwent Hospital, Newport, United Kingdom
| | - Carl D Passant
- Department of Otorhinolaryngology Head and Neck Surgery, Aneurin Bevan University Health Board, The Royal Gwent Hospital, Newport, United Kingdom
| | - Duncan R Ingrams
- Department of Otorhinolaryngology Head and Neck Surgery, Aneurin Bevan University Health Board, The Royal Gwent Hospital, Newport, United Kingdom
| |
Collapse
|
23
|
Management of the thyroid gland during laryngectomy. The Journal of Laryngology & Otology 2017; 131:740-744. [PMID: 28592347 DOI: 10.1017/s0022215117001244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES This study aimed to: describe the incidence of thyroid gland involvement in advanced laryngeal cancer, analyse patterns of spread to the thyroid and elucidate predictors of thyroid involvement. METHODS A retrospective review was performed on patients who underwent laryngectomy from 1991 to 2015 as a primary or salvage treatment for squamous cell carcinoma of the larynx, hypopharynx or base of tongue. The incidence of thyroidectomy during total laryngectomy, type of thyroidectomy, incidence of gland involvement, route of spread, and positive predictors of spread were analysed and reported. RESULTS A total of 188 patients fit the inclusion criteria. Of these, 125 (66 per cent) underwent thyroidectomy. The thyroid was involved in 10 of the 125 patients (8 per cent), 9 by direct extension and 1 by metastasis. Cartilage invasion was a predictor of thyroid gland involvement, with a positive predictive value of 26 per cent. CONCLUSION There is a low incidence of thyroid gland involvement in laryngeal carcinoma. Most cases of gland involvement occurred by direct extension. Thyroidectomy during laryngectomy should be considered for advanced stage tumours with cartilage invasion.
Collapse
|
24
|
Ahn SH, Hong HJ, Kwon SY, Kwon KH, Roh JL, Ryu J, Park JH, Baek SK, Lee GH, Lee SY, Lee JC, Chung MK, Joo YH, Ji YB, Hah JH, Kwon M, Park YM, Song CM, Shin SC, Ryu CH, Lee DY, Lee YC, Chang JW, Jeong HM, Cho JK, Cha W, Chun BJ, Choi IJ, Choi HG, Lee KD. Guidelines for the Surgical Management of Laryngeal Cancer: Korean Society of Thyroid-Head and Neck Surgery. Clin Exp Otorhinolaryngol 2017; 10:1-43. [PMID: 28043099 PMCID: PMC5327593 DOI: 10.21053/ceo.2016.01389] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 10/24/2016] [Indexed: 01/08/2023] Open
Abstract
Korean Society of Thyroid-Head and Neck Surgery appointed a Task Force to develop clinical practice guidelines for the surgical treatment of laryngeal cancer. This Task Force conducted a systematic search of the EMBASE, MEDLINE, Cochrane Library, and KoreaMed databases to identify relevant articles, using search terms selected according to the key questions. Evidence-based recommendations were then created on the basis of these articles. An external expert review and Delphi questionnaire were applied to reach consensus regarding the recommendations. The resulting guidelines focus on the surgical treatment of laryngeal cancer with the assumption that surgery is the selected treatment modality after a multidisciplinary discussion in any context. These guidelines do not, therefore, address non-surgical treatment such as radiation therapy or chemotherapy. The committee developed 62 evidence-based recommendations in 32 categories intended to assist clinicians during management of patients with laryngeal cancer and patients with laryngeal cancer, and counselors and health policy-makers.
Collapse
Affiliation(s)
- Korean Society of Thyroid-Head and Neck Surgery Guideline Task Force
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulsan College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chosun University College of Medicine, Gwangju, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Daejin Medical Center, Bundang Jesaeng Hospital, Seongnam, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Seonam University College of Medicine, Goyang, Korea
- Department of Otorhinolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun Jun Hong
- Department of Otorhinolaryngology Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Soon Young Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Kee Hwan Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Jong-Lyel Roh
- Department of Otorhinolaryngology Head and Neck Surgery, University of Ulsan College of Medicine, Seoul, Korea
| | - Junsun Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Jun Hee Park
- Department of Otorhinolaryngology Head and Neck Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Guk Haeng Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Sei Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jin Choon Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Man Ki Chung
- Department of Otorhinolaryngology Head and Neck Surgery, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hoon Joo
- Department of Otorhinolaryngology Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yong Bae Ji
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Jeong Hun Hah
- Department of Otorhinolaryngology Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Minsu Kwon
- Department of Otorhinolaryngology Head and Neck Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Min Park
- Department of Otorhinolaryngology Head and Neck Surgery, Daejin Medical Center, Bundang Jesaeng Hospital, Seongnam, Korea
| | - Chang Myeon Song
- Department of Otorhinolaryngology Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
| | - Sung-Chan Shin
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Chang Hwan Ryu
- Department of Otorhinolaryngology Head and Neck Surgery, National Cancer Center, Goyang, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Young Chan Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jae Won Chang
- Department of Otorhinolaryngology Head and Neck Surgery, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ha Min Jeong
- Department of Otorhinolaryngology Head and Neck Surgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Jae-Keun Cho
- Department of Otorhinolaryngology Head and Neck Surgery, Inje University College of Medicine, Busan, Korea
| | - Wonjae Cha
- Department of Otorhinolaryngology Head and Neck Surgery, Pusan National University School of Medicine, Busan, Korea
| | - Byung Joon Chun
- Department of Otorhinolaryngology Head and Neck Surgery, Seonam University College of Medicine, Goyang, Korea
| | - Ik Joon Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Korea Cancer Center Hospital, Seoul, Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology Head and Neck Surgery, Hallym University College of Medicine, Seoul, Korea
| | - Kang Dae Lee
- Department of Otorhinolaryngology Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
| |
Collapse
|
25
|
Wiegand S. Evidence and evidence gaps of laryngeal cancer surgery. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2016; 15:Doc03. [PMID: 28025603 PMCID: PMC5169076 DOI: 10.3205/cto000130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Surgical treatment of laryngeal cancer has been established for decades. In addition to total laryngectomy, which was first performed in 1873, a large number or organ preservation surgical techniques, like open partial laryngectomy, transoral laser microsurgery, and transoral robotic surgery have been developed. Studies on laryngeal cancer surgery are mainly retrospective case series and cohort studies. The evolution of chemoradiation protocols and their analysis in prospective randomized trials have led to an increasing acceptance of non-surgical treatment procedures. In addition to an improvement of prognosis, in recent years the preservation of function and maintenance of life quality after primary therapy of laryngeal cancer has increasingly become the focus of therapy planning. Significant late toxicity after chemoradiation has been identified as an important issue. This leads to a reassessment of surgical concepts and initiation of studies on laryngeal cancer surgery which was additionally stimulated by the advent of transoral robotic surgery in the US. Improving the evidence base of laryngeal cancer surgery by successful establishment of surgical trials should be the future goal.
Collapse
Affiliation(s)
- Susanne Wiegand
- Department of Otolaryngology, Head & Neck Surgery, University Hospital of Leipzig, Germany
| |
Collapse
|
26
|
Lin P, Huang X, Zheng C, Cai Q, Guan Z, Liang F, Zheng Y. The predictive value of MRI in detecting thyroid gland invasion in patients with advanced laryngeal or hypopharyngeal carcinoma. Eur Arch Otorhinolaryngol 2016; 274:361-366. [PMID: 27520569 DOI: 10.1007/s00405-016-4258-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/09/2016] [Indexed: 10/21/2022]
Abstract
The aim of this study was to evaluate the predictive value of magnetic resonance imaging (MRI) in detecting thyroid gland invasion (TGI) in patients with advanced laryngeal or hypopharyngeal carcinoma. In a retrospective chart review, 41 patients with advanced laryngeal or hypopharyngeal carcinoma underwent MRI scan before total laryngectomy and ipsilateral or bilateral thyroidectomy during the past 5 years. The MRI findings were compared with the postoperative pathological results. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. Among the 41 patients, 3 had thyroid gland invasion in postoperative pathological results. MRI correctly predicted the absence of TGI in 37 of 38 patients and TGI in all 3 patients. The sensitivity, specificity, PPV, and NPV of MRI were 100.0, 97.4, 75.0, and 100 %, respectively, with the diagnostic accuracy of 97.6 %. In consideration of the high negative predictive value of MRI, it may help surgeons selectively preserve thyroid gland in total laryngectomy and reduce the incidence of hypothyroidism and hypoparathyroidism postoperatively.
Collapse
Affiliation(s)
- Peiliang Lin
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107, Yanjiang West Road, Guangzhou, 510120, Guangdong, China
| | - Xiaoming Huang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107, Yanjiang West Road, Guangzhou, 510120, Guangdong, China
| | - Chushan Zheng
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107, Yanjiang West Road, Guangzhou, 510120, Guangdong, China
| | - Qian Cai
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107, Yanjiang West Road, Guangzhou, 510120, Guangdong, China
| | - Zhong Guan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107, Yanjiang West Road, Guangzhou, 510120, Guangdong, China
| | - Faya Liang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107, Yanjiang West Road, Guangzhou, 510120, Guangdong, China
| | - Yiqing Zheng
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Department of Otolaryngology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, 107, Yanjiang West Road, Guangzhou, 510120, Guangdong, China.
| |
Collapse
|
27
|
Management of thyroid gland invasion in laryngeal and hypopharyngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol 2015; 273:511-5. [DOI: 10.1007/s00405-015-3828-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 10/29/2015] [Indexed: 10/22/2022]
|
28
|
Gorphe P, Ben Lakhdar A, Tao Y, Breuskin I, Janot F, Temam S. Evidence‐based management of the thyroid gland during a total laryngectomy. Laryngoscope 2015; 125:2317-22. [DOI: 10.1002/lary.25417] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2015] [Indexed: 11/10/2022]
|