1
|
Li M, Tang Q, Yang X, Yang Q, Zeng M, Zhang Y, Huang P, Yin D, Li S. Application of modified spiral tracheoplasty in thyroid carcinoma with trachea invasion: a retrospective analysis of 15 cases. World J Surg Oncol 2024; 22:264. [PMID: 39363373 PMCID: PMC11448305 DOI: 10.1186/s12957-024-03541-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 09/21/2024] [Indexed: 10/05/2024] Open
Abstract
BACKGROUND To describe the indications, techniques and preliminary experience of modified spiral tracheoplasty in the reconstruction of large tracheal defect after thyroidectomy. METHODS The medical records of patients who underwent tracheal torsion to repair large tracheal defects after thyroid carcinoma surgery from January 2019 to January 2022 were retrospectively reviewed. The extent of tracheal defect, duration of tracheal reconstruction, postoperative complications and surgery results were analyzed. RESULTS The duration of tracheal reconstruction was 30-60 min. No postoperative bleeding, incision infection, tracheostomy stenosis occurred. Recurrent laryngeal nerve palsy occurred in 5 patients. All patients were followed up for 24 to 60 months. The 2-year overall survival rate was 100%, the 2-year local control rate of trachea was 100%, and the 2-year tumor-free survival rate was 81.8%. CONCLUSION The modified spiral tracheoplasty is a safe and effective method to repair the large defect of trachea after thyroid carcinoma invading the trachea.
Collapse
Affiliation(s)
- Mengmeng Li
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Qinglai Tang
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Xinming Yang
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Qian Yang
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Miao Zeng
- Department of Operating Room, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Yuming Zhang
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Peiying Huang
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Danhui Yin
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
| | - Shisheng Li
- Department of Otorhinolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
| |
Collapse
|
2
|
Raffaelli M, Voloudakis N, Barczynski M, Brauckhoff K, Durante C, Gomez-Ramirez J, Koutelidakis I, Lorenz K, Makay O, Materazzi G, Pandev R, Randolph GW, Tolley N, Vriens M, Musholt T. European Society of Endocrine Surgeons (ESES) consensus statement on advanced thyroid cancer: definitions and management. Br J Surg 2024; 111:znae199. [PMID: 39158073 PMCID: PMC11331340 DOI: 10.1093/bjs/znae199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 06/16/2024] [Accepted: 07/15/2024] [Indexed: 08/20/2024]
Affiliation(s)
- Marco Raffaelli
- UOC Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Centro di Ricerca in Chirurgia delle Ghiandole Endocrine e dell’Obesità (CREO), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nikolaos Voloudakis
- UOC Chirurgia Endocrina e Metabolica, Centro Dipartimentale di Chirurgia Endocrina e dell’Obesità, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Marcin Barczynski
- Department of Endocrine Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Katrin Brauckhoff
- Department of Breast and Endocrine Surgery, Haukeland University Hospital, Bergen, Norway
| | - Cosimo Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Joaquin Gomez-Ramirez
- Endocrine Surgery Unit, General Surgery Department, Hospital Universitario La Paz, IdiPaz Madrid, Madrid, Spain
| | - Ioannis Koutelidakis
- Second Surgical Department, Aristotle University of Thessaloniki, G. Gennimatas Hospital, Thessaloniki, Greece
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ozer Makay
- Centre for Endocrine Surgery, Ozel Saglik Hospital, Izmir, Turkey
| | - Gabriele Materazzi
- Department of Surgical, Medical and Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | - Rumen Pandev
- Department of General Surgery, University Hospital St Marina, Medical University Pleven, Pleven, Bulgaria
| | - Gregory W Randolph
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
| | - Neil Tolley
- Endocrine Surgery Service, Imperial College NHS Healthcare Trust, London, UK
| | - Menno Vriens
- Department of Surgical Oncology and Endocrine Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Thomas Musholt
- Section of Endocrine Surgery, Department of General, Visceral and Transplantation Surgery, University Medicine Mainz, Mainz, Germany
| |
Collapse
|
3
|
Ho AZJ, Abdul Wahab AH, Rozhan A. A Case on Papillary Thyroid Carcinoma With Intraluminal Tracheal Extension: A Malaysian Experience and Literature Review. Cureus 2024; 16:e61712. [PMID: 38975550 PMCID: PMC11225092 DOI: 10.7759/cureus.61712] [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] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
Papillary thyroid carcinoma (PTC) is a common malignancy originating from the thyroid gland. In rare cases, it can invade the trachea, resulting in airway obstruction. Subsequent surgical planning may be complicated as the technique selected depends on a case-by-case basis. Here, we report a case of PTC with tracheal involvement and a literature review on the latest surgical options. A 56-year-old gentleman presented with an anterior neck swelling of 3 x 3 cm for 3 months. Flexible endoscopy showed irregular mass in the subglottic region. Subsequent aspiration for cytology confirmed a diagnosis of PTC. Neck contrast enhanced computed tomography showed an ill-defined lesion in the right thyroid (3.1 x 3.8 x 2.9 cm) with a subtle irregularity of the adjacent tracheal wall suggestive of infiltration. The findings indicated a clinical staging of cT4aN0M0 (Stage III) with Shin's staging of Stage IV. The patient underwent a total thyroidectomy and a single-stage partial cricoid-tracheal resection with anastomosis. There were no immediate post-operative complications reported. Unfortunately, the patient suffered from pulmonary embolism, which eventually resulted in his demise. A subsequent histopathology report confirmed the diagnosis of PTC. Surgical planning for such cases may be complicated. The risk of recurrent laryngeal nerve injury is increased as the site of resection is close to the nerve. Multiple intraoperative nerve monitoring systems may be required. Meticulous planning of intraoperative airway management is needed as a large intraluminal tumor may interfere with intubation. Generally, extensive tracheal invasion would require radical surgical approaches such as circumferential resection and total laryngectomy. Less extensive cases can be treated with shave excision or window resection. PTC with tracheal invasion is an uncommon condition, and surgical excision is indicated for cases with high Shin's staging.
Collapse
Affiliation(s)
- Alex Zxi Jian Ho
- Department of Otolaryngology, Head and Neck Surgery, International Islamic University Malaysia, Kuantan, MYS
| | - Azwan Halim Abdul Wahab
- Department of Otolaryngology, Head and Neck Surgery, International Islamic University Malaysia, Kuantan, MYS
| | - Atikah Rozhan
- Department of Otolaryngology, Head and Neck Surgery, International Islamic University Malaysia, Kuantan, MYS
| |
Collapse
|
4
|
Kong Z, Wang J, Ni S, Liu Y, Zhao X, Zhu Y, Li L, Liu S. CT-based quantification of trachea shape to detect invasion by thyroid cancer. Eur Radiol 2024; 34:3141-3150. [PMID: 37926738 DOI: 10.1007/s00330-023-10301-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE This study aims to develop a CT-based method for quantifying tracheal shape and evaluating its ability to distinguish between cases with or without tracheal invasion in patients with thyroid carcinoma. METHODS A total of 116 quantitative shape features, including 56 geometric moments and 60 bounding shape features, were defined. The tracheal lumen was semi-automatically defined with a CT threshold of less than - 500 HU. Three contiguous slices with the 1st, 2nd, and 3rd smallest trachea lumen areas were contiguously selected, and the appropriate number of slices to be included was determined. Fifty-six patients with differentiated thyroid carcinoma (DTC) invading the trachea and 22 patients with DTC but without invasion were retrospectively included. A receiver operating characteristic (ROC) curve was applied to select the representative shape features and determine the optimal threshold. RESULTS 23.3%, 25.9%, and 24.1% of the features displayed an area under the ROC curve (AUC) ≥ 0.800 when derived from 1, 2, and 3 slices, respectively. Calculating feature values from two slices with the 1st and 2nd smallest tracheal lumen area were considered appropriate. Six final features, including 3 geometric moments and 3 bounding shape features, were selected to determine the tracheal invasion status of DTC and displayed AUCs of 0.875-0.918, accuracies of 0.821-0.891, sensitivities of 0.813-0.893, and specificities of 0.818-0.932, outperforming the visual evaluation results. CONCLUSIONS Geometric moments and bounding shape features can quantify the tracheal shape and are reliable for identifying DTC tracheal invasion. The selected features quantified the extent of tracheal deformity in DTC patients with and without tracheal invasion. CLINICAL RELEVANCE STATEMENT Six geometric features provide a non-invasive, semi-automated evaluation of the tracheal invasion status of thyroid cancer. KEY POINTS • A novel method for quantifying tracheal shape using 56 geometric moments and 60 bounding shape features was developed. • Six features identify tracheal invasion by thyroid carcinoma. • The selected features quantified the extent of tracheal deformity in differentiated thyroid carcinoma patients with and without tracheal invasion.
Collapse
Affiliation(s)
- Ziren Kong
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuannanli, Chaoyang District, Beijing, China
| | - Jian Wang
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuannanli, Chaoyang District, Beijing, China
| | - Song Ni
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuannanli, Chaoyang District, Beijing, China
| | - Yang Liu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuannanli, Chaoyang District, Beijing, China
| | - Xinming Zhao
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuannanli, Chaoyang District, Beijing, China
| | - Yiming Zhu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuannanli, Chaoyang District, Beijing, China.
| | - Lin Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17, Panjiayuannanli, Chaoyang District, Beijing, China.
| | - Shaoyan Liu
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No.17 Panjiayuannanli, Chaoyang District, Beijing, China.
| |
Collapse
|
5
|
Ding Y, Gu L, Wang L, Xing L, Zhou Y, Jiang Y. Anesthetic management of thyroid carcinoma invading the upper tracheal segment: A case report. Int J Surg Case Rep 2024; 117:109427. [PMID: 38452638 PMCID: PMC10926285 DOI: 10.1016/j.ijscr.2024.109427] [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: 01/02/2024] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 03/09/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Intratracheal tumors account for approximately 0.2 % of respiratory tumors, including primary and secondary tumors. Secondary tumors of the upper trachea are most commonly derived from advanced thyroid cancer. Surgical resection is currently the general curative modality for thyroid cancer with tracheal invasion. Patients with tracheal tumors invading and protruding into the lumen may have reduced oxygen reserve capacity, leading to a shorter safe window for general anesthesia induction. Establishing an appropriate artificial airway is essential to ensure intraoperative safety for these patients. Here, we report a case of tracheal tumor caused by differentiated papillary thyroid carcinoma invading the upper segment of the trachea and the non-conventional approach used for intraoperative airway management without traditional endotracheal intubation. PRESENTATION OF CASE A 59-year-old female presented with bilateral neck masses and hemoptysis. The CT scan revealed suspicious malignant thyroid nodules, and tracheoscopy showed an approximately 50 % obstruction of the tracheal lumen. The patient's physical examination and biochemical examination showed no significant abnormalities. Based on imaging studies and pre-anesthetic assessment, a multidisciplinary team decided against performing endotracheal intubation in the patient due to the risk of tumor bleeding during the procedure. Instead, they opted for a modified endotracheal tube and the insertion of a laryngeal mask airway (LMA). The anesthesia induction and maintenance proceeded smoothly, with stable intraoperative hemodynamics. The tumor was successfully resected and tracheal anastomosis was performed without any complications. CLINICAL DISCUSSION The strategy adroitly evades the risk of bleeding and dislodgement due to tumor contact during the intubation process. In this case report, the anesthetic highlight is the employment of a reverse insertion technique for endotracheal intubation, facilitated by a sterile suction catheter and complemented by an innovative modification to the tracheal tube. CONCLUSION For patients with thyroid cancer invading the upper segment of the trachea, and in whom rapid induction anesthesia is anticipated not to cause tumor collapse, the use of laryngeal mask airway combined with modified tracheal tube mechanical ventilation is both safe and feasible.
Collapse
Affiliation(s)
- Yuyan Ding
- The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
| | - Lianbing Gu
- The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China.
| | - Lijun Wang
- Jiangsu Cancer Hospital anesthesiology department, Nanjing 210009, China
| | - Lingxi Xing
- The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
| | - Yihu Zhou
- The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
| | - Yueyi Jiang
- The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing 210009, China
| |
Collapse
|
6
|
Inoue Y, Ebina A, Toda K, Shimbashi W, Yamada K, Mitani H, Tanaka Y, Sugitani I. Surgical strategy for patients with papillary thyroid carcinoma invading the trachea: a comparison of tracheal sleeve resection with end-to-end anastomosis and window resection with tracheocutaneous fistula. Gland Surg 2023; 12:1167-1178. [PMID: 37842530 PMCID: PMC10570975 DOI: 10.21037/gs-23-171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/02/2023] [Indexed: 10/17/2023]
Abstract
Background Sleeve resection with end-to-end anastomosis (Procedure A) and window resection with a tracheocutaneous fistula (Procedure B) are the major surgical procedures for patients with papillary thyroid carcinoma (PTC) exhibiting transluminal tracheal invasion. For each procedure, the indications, postoperative course, and treatment results were examined retrospectively. Methods Of 1,456 patients with PTC (maximum tumor diameter >1 cm) who received initial treatment between 1993 and 2013, we reviewed 51 patients. Of these 51 cases, 45 showed full-layer tracheal invasion, and 6 did not reach the tracheal mucosa, but required full-layer tracheal resection. Twenty-four patients underwent Procedure A, and 27 patients underwent Procedure B. Results Regarding surgical procedure selection, Procedure B was selected significantly more frequently than Procedure A for cases with preoperative recurrent laryngeal nerve (RLN) palsy, tumor invasion of the esophagus, clinical lymph node metastasis, or a large number of resected tracheal rings. Postoperative airway-related complications were not significantly different between the procedures, but decreased with the use of intraoperative neuromonitoring (IONM). The postoperative hospital stay was significantly longer for Procedure B than for Procedure A. In addition, the rate of a permanent postoperative tracheostoma was higher with Procedure B than with Procedure A. Local recurrence-free survival (LRFS) and cause-specific survival (CSS) did not differ significantly between the two procedures. Conclusions Certain patients may benefit from Procedure A with IONM in terms of a shorter hospital stay and avoiding the need for a permanent tracheostoma. Although Procedure B was indicated for patients with more advanced disease than Procedure A, treatment outcomes were similar.
Collapse
Affiliation(s)
- Yukari Inoue
- Department of Otorhinolaryngology and Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Aya Ebina
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Toda
- Division of Head and Neck, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Wataru Shimbashi
- Division of Head and Neck, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Keiko Yamada
- Division of Ultrasonography, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Hiroki Mitani
- Division of Head and Neck, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| | - Yasuhiro Tanaka
- Department of Otorhinolaryngology and Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Iwao Sugitani
- Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
- Division of Head and Neck, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan
| |
Collapse
|
7
|
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.
Collapse
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.
| |
Collapse
|
8
|
Cavalheiro BG, Shah JP, Randolph GW, Medina JE, Tufano RP, Zafereo M, Hartl DM, Nixon IJ, Guntinas-Lichius O, Vander Poorten V, López F, Khafif AH, Owen RP, Shaha A, Rodrigo JP, Rinaldo A, Mäkitie AA, Silver CE, Sanabria A, Kowalski LP, Ferlito A. Management of Recurrent Well-Differentiated Thyroid Carcinoma in the Neck: A Comprehensive Review. Cancers (Basel) 2023; 15:923. [PMID: 36765880 PMCID: PMC9913047 DOI: 10.3390/cancers15030923] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/25/2023] [Accepted: 01/30/2023] [Indexed: 02/04/2023] Open
Abstract
Surgery has been historically the preferred primary treatment for patients with well-differentiated thyroid carcinoma and for selected locoregional recurrences. Adjuvant therapy with radioactive iodine is typically recommended for patients with an intermediate to high risk of recurrence. Despite these treatments, locally advanced disease and locoregional relapses are not infrequent. These patients have a prolonged overall survival that may result in long periods of active disease and the possibility of requiring subsequent treatments. Recently, many new options have emerged as salvage therapies. This review offers a comprehensive discussion and considerations regarding surgery, active surveillance, radioactive iodine therapy, ultrasonography-guided percutaneous ablation, external beam radiotherapy, and systemic therapy for well-differentiated thyroid cancer based on relevant publications and current reference guidelines. We feel that the surgical member of the thyroid cancer management team is empowered by being aware and facile with all management options.
Collapse
Affiliation(s)
- Beatriz G. Cavalheiro
- Cancer Institute of São Paulo State, Department of Head and Neck Surgery, University of São Paulo Medical School, Sao Paulo 01246-903, Brazil
| | - Jatin P. Shah
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Gregory W. Randolph
- Department of Otolaryngology Head and Neck Surgery, Harvard Medical School, Boston, MA 02115, USA
| | - Jesus E. Medina
- Department of Otolaryngology and Head and Neck Surgery, University of Oklahoma College of Medicine, Oklahoma City, OK 73104, USA
| | - Ralph P. Tufano
- Multidisciplinary Thyroid and Parathyroid Center, Head and Neck Endocrine Surgery, Sarasota Memorial Health Care System, Sarasota, FL 34239, USA
| | - Mark Zafereo
- Department of Head & Neck Surgery, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Dana M. Hartl
- Department of Surgery, Gustave Roussy, 94800 Villejuif, France
| | - Iain J. Nixon
- Department of Otolaryngology Head and Neck Surgery, NHS Lothian, University of Edinburgh, Edinburgh EH8 9YL, UK
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology-Head and Neck Surgery, Jena University Hospital, 07747 Jena, Germany
| | - Vincent Vander Poorten
- Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Fernando López
- ENT and Head and Neck Department, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, 33011 Oviedo, Spain
- Centro de Investigación Biomédica en Red de Cancer (CIBERONC), 28029 Madrid, Spain
| | - Avi Hefetz Khafif
- Assuta Medical Center, Ben-Gurion University of the Negev, Tel Aviv 8436322, Israel
| | - Randall P. Owen
- Section of Endocrine Surgery, Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital, Icahn School of Medicine, New York, NY 10029, USA
| | - Ashok Shaha
- Head and Neck Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
| | - Juan P. Rodrigo
- ENT and Head and Neck Department, Hospital Universitario Central de Asturias, University of Oviedo, ISPA, IUOPA, 33011 Oviedo, Spain
- Centro de Investigación Biomédica en Red de Cancer (CIBERONC), 28029 Madrid, Spain
| | | | - Antti A. Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, 00290 Helsinki, Finland
| | - Carl E. Silver
- Department of Surgery, University of Arizona College of Medicine, Phoenix, AZ 85724, USA
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, University of Antioquia, Medellín 0500100, Colombia
| | - Luiz P. Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, AC Camargo Cancer Center, Sao Paulo 01509-001, Brazil
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo 01246-903, Brazil
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, 35125 Padua, Italy
| |
Collapse
|
9
|
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] [Revised: 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.
Collapse
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
| |
Collapse
|
10
|
Zhu X, Sun K, Xia X, Chen Y, Sun A, Chen X. A preliminary biomechanical study on trachea reconstruction surgery using the clavicular periosteum. Front Bioeng Biotechnol 2023; 11:1117483. [PMID: 36733972 PMCID: PMC9888552 DOI: 10.3389/fbioe.2023.1117483] [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: 12/06/2022] [Accepted: 01/03/2023] [Indexed: 01/18/2023] Open
Abstract
Introduction: The clavicular periosteum is a suitable material for trachea reconstruction. However, because the periosteum is softer and has different mechanical properties than tracheal cartilage, the mechanical loads under physiological conditions after trachea reconstruction may cause collapse or stenosis of the repaired trachea. Methods: In this study, the mechanical properties of the clavicular periosteum were tested, and the 3D trachea geometry was constructed based on CT-scanning images acquired before the surgery. Differing degrees of stenosis (0%, 33%, and 55%) for the repaired trachea sections were predetermined, presenting the different degrees of the tracheal cross-sectional area immediately after clavicular periosteum reconstruction. Then the biomechanical environments of the trachea and the airflow were simulated and analyzed. Results: In the fluid mechanics simulation, the air pressure on the patch area decreased with increasing degrees of stenosis, while the fluid velocity increased as stenosis increased. In solid mechanics simulations, patch area deformation increased as the cross-sectional area of the trachea decreased, and the stress in the patch increased as stenosis increased. Discussion: The solid stress changes may cause tissue remodeling, thickening, and scarring of the patch area. The fluid mechanical changes in the repaired trachea would further aggravate the stenosis. The numerical simulation study would provide references for biomechanical evaluation of trachea reconstruction surgery. The surgical indications may be expanded in the future based on the model prediction results.
Collapse
Affiliation(s)
- Xiaoli Zhu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Kangli Sun
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Xin Xia
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yu Chen
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Anqiang Sun
- Key Laboratory for Biomechanics and Mechanobiology of Ministry of Education, Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China,*Correspondence: Xingming Chen, ; Anqiang Sun,
| | - Xingming Chen
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China,*Correspondence: Xingming Chen, ; Anqiang Sun,
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Ševčíková MK, Ševčík K, Figurová M, Agyagosová-Valenčáková A, Hluchý M, Horňáková L, Lapšanská M, Kerekes Z, Žert Z. Retrospective analysis of tracheal hypoplasia in brachycephalic and non-brachycephalic dogs: Inter- and intra-observer agreement of measurements. Acta Vet Hung 2022; 70:192-200. [PMID: 36057869 DOI: 10.1556/004.2022.00018] [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: 10/11/2021] [Accepted: 07/21/2022] [Indexed: 11/19/2022]
Abstract
This retrospective study was undertaken on the records of intraluminal diameter of the trachea in 185 dogs, in which hypoplasia of the trachea had been suspected. The relative size of the trachea was measured using the tracheal diameter (TD), thoracic inlet distance (TI), thoracic tracheal diameter (TT) and the width of the third rib (3R), expressed as ratios TD:TI and TT:3R. Thirty-five dogs were diagnosed as having tracheal hypoplasia. Bulldogs and non-bulldog brachycephalic dogs had significantly smaller measured trachea diameters compared to the predicted values calculated on the basis of their body weight. Radiographs of each dog were investigated by four observers. Inter- and intra-observer reliability (ICCinter, ICCintra) was based on the measurements taken by four observers to evaluate the reproducibility of the protocol. There was a good ICCinter (0.8) and ICCintra (0.89) agreement. Craniocaudal tangential radiographs, centred on the cranial thoracic aperture, did not show a significant difference in tracheal diameter measurements compared to the right lateral radiographs. In conclusion, our findings indicate that bulldogs and non-bulldog brachycephalic dogs have smaller tracheal diameters than non-brachycephalic dogs.
Collapse
Affiliation(s)
- Marieta K Ševčíková
- 1 Small Animal Clinic, University of Veterinary Medicine and Pharmacy, Komenského 73, 041 81 Košice, Slovakia
| | - Karol Ševčík
- 1 Small Animal Clinic, University of Veterinary Medicine and Pharmacy, Komenského 73, 041 81 Košice, Slovakia
| | - Mária Figurová
- 1 Small Animal Clinic, University of Veterinary Medicine and Pharmacy, Komenského 73, 041 81 Košice, Slovakia
| | | | - Marián Hluchý
- 1 Small Animal Clinic, University of Veterinary Medicine and Pharmacy, Komenského 73, 041 81 Košice, Slovakia
| | - L'ubica Horňáková
- 1 Small Animal Clinic, University of Veterinary Medicine and Pharmacy, Komenského 73, 041 81 Košice, Slovakia
| | - Mária Lapšanská
- 1 Small Animal Clinic, University of Veterinary Medicine and Pharmacy, Komenského 73, 041 81 Košice, Slovakia
| | - Zoltán Kerekes
- 2 Clinic of Horses, University of Veterinary Medicine and Pharmacy, Komenského 73, 041 81, Košice, Slovakia
- 4 VetScan Pet Diagnostics, Budapest, Hungary
| | - Zdeněk Žert
- 3 University of Veterinary Medicine Budapest, Budapest, Hungary
| |
Collapse
|
13
|
Surgery for Thyroid Cancer Invading the Trachea. Indian J Surg Oncol 2022; 13:184-190. [PMID: 35462665 PMCID: PMC8986919 DOI: 10.1007/s13193-021-01466-7] [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: 08/19/2021] [Accepted: 10/19/2021] [Indexed: 10/20/2022] Open
Abstract
Thyroid cancer invading the trachea can be asymptomatic, but when tumour invasion reaches the mucosal surface, it causes bloody sputum and dyspnoea. The treatment plan for thyroid cancer is determined based on the site, depth, and extent of the invasion. Different from tumours arising from the tracheal mucosa, in thyroid cancer, invasion begins outside the airway and progresses toward the lumen, making it difficult to accurately diagnose the extent of the invasion even with bronchoscopy. Therefore, surgeons must determine the range of resection during surgery. Invasion reaching the tracheal mucosa requires full-thickness resection and is performed using tracheal window resection combined with tracheocutaneous fistula or tracheal sleeve resection followed by end-to-end anastomosis. The airway is safely secured with window resection, but closing the tracheal stoma often requires multi-stage reconstruction. Sleeve resection is an oncologically appropriate surgical method that can be completed in one stage, although there is a risk of serious complications associated with anastomotic dehiscence. Since well-differentiated thyroid cancer progresses slowly, some degree of survival can be expected even with incomplete resection. However, when shaving is performed for tumours with deep invasion that reaches the tracheal mucosa, the residual tumour tissue continues to grow steadily and eventually leads to airway stenosis. Since reoperation for tracheal resection is difficult, radical full-thickness resection should be performed in the initial surgery. Although this surgical intervention is far more demanding for both patients and surgeons than shaving, the procedure eventually improves patient's prognosis and quality of life.
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|