Background
The appropriate resection for thyroid cancer invading the aerodigestive tract remains
controversial.
Methods
A total of 174 patients underwent resections for aerodigestive tract invasion from
differentiated thyroid cancer (103 patients), medullary thyroid cancer (40 patients),
and undifferentiated thyroid cancers/unusual thyroid neoplasms (31 patients). In all,
82 patients submitted to transmural resections (window resection, sleeve resection,
or cervical evisceration), 65 patients underwent nontransmural resections (shaving
or extramucosal esophageal resections), and 27 patients had grossly incomplete resections.
The measures of outcome included surgical morbidity, locoregional recurrence, and
disease-specific survival.
Results
Surgical morbidity was 38% after transmural and 25% after nontransmural resection
(P = .02). On histopathologic examination, surgical margins were microscopically involved
in 9% of patients after transmural and 23% of patients after nontransmural resection
(P = .014). At a mean follow-up of 35.3 months, locoregional recurrence developed in
10 (46%) of 22 patients with microscopically incomplete and 18 (15%) of 121 patients
with microscopically complete resection (P = .001). After grossly complete resection, the mean disease-specific survival was
101.2, 69.8, and 25.5 months for differentiated thyroid cancer, medullary thyroid
cancer, and undifferentiated thyroid cancer/unusual neoplasms, respectively (P < .001). This outcome was independent of the type of resection.
Conclusion
The type of cancer and resection are key determinants of outcome among thyroid cancer
patients with aerodigestive tract invasion.
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References
- Surgical management of advanced thyroid cancer invading the aerogigestive tract.in: Clark O.H. Duh Q.Y. Kebebew E. Textbook on endocrine surgery. 2nd edition. Elsevier Saunders, Philadelphia (PA)2005: 318-333
- Immediate causes of death in thyroid carcinoma: clinicopathological analysis of 161 fatal cases.J Clin Endocrinol Metab. 1999; 84: 4043-4048
- Death from thyroid cancer of follicular cell origin.J Am Coll Surg. 2000; 191: 600-606
- Aggressive surgical approach for locally invasive papillary carcinoma of the thyroid in patients over forty-five years of age.Surgery. 1986; 100: 1098-1107
- Resectional management of thyroid carcinoma invading the airway.Ann Thorac Surg. 1992; 54: 3-10
- Invasive differentiated thyroid carcinoma: tracheal resection and reconstruction procedures in the hands of the endocrine surgeon.Surgery. 1999; 126: 1078-1088
- Long-term results and functional outcome after cervical evisceration in patients with thyroid cancer.Surgery. 2006; 140: 953-995
- Segmental laryngotracheal and tracheal resection for invasive thyroid carcinoma.Ann Thorac Surg. 2007; 83: 1952-1959
- Thyroid carcinoma infiltrating the trachea: clinical, histologic, and morphometric analyses.J Surg Oncol. 1990; 44: 78-83
- Surgical treatment of invasion of the upper aerodigestive tract by well-differentiated thyroid carcinoma.Am J Surg. 1987; 154: 363-367
- Thyroid carcinoma with tracheal or esophageal involvement: limited or maximal surgery?.Surgery. 1993; 113: 166-172
- Treatment of patients with carcinoma of the thyroid invading the airway.Arch Otolaryngol Head Neck Surg. 1994; 120: 1377-1381
- Locally invasive papillary thyroid carcinoma: 1940-1990.Head Neck. 1994; 4: 165-172
- The surgical management of laryngotracheal invasion by well-differentiated papillary thyroid carcinoma.Arch Otolaryngol Head Neck Surg. 1997; 123: 484-490
- Invasive well-differentiated thyroid carcinoma: effect of treatment modalities on outcome.Otolaryngol Head Neck Surg. 2006; 134: 819-822
- Sobin L.H. Ch Wittekind TNM classification of malignant tumours. Wiley-Liss, Inc., New York2002
- Thyroid carcinoma invading the cervicovisceral axis: routes of invasion and clinical implications.Surgery. 2001; 129: 23-28
- Pathologic staging of papillary carcinoma of the thyroid with airway invasion based on the anatomic manner of extension to the trachea: a clinicopathologic study based on 22 patients who underwent thyroidectomy and airway resection.Hum Pathol. 1993; 24: 866-870
- Surgery for patients with thyroid carcinoma invading the trachea: circumferential sleeve resection followed by end-to-end anastomosis.Surgery. 1995; 117: 268-271
- Management of thyroid carcinoma invading the aerodigestive tract.Laryngoscope. 1998; 108: 1402-1407
- Aggressive resection of the airway invaded by thyroid carcinoma.Br J Surg. 2005; 92: 1382-1387
- Differentiated thyroid cancer – impact of adjuvant external radiotherapy in patients with perithyroidal tumor infiltration (stage pT4).Cancer. 1996; 77: 172-180
- Clinical outcomes of adjuvant external-beam radiotherapy for differentiated thyroid cancer - results after 874 patient-years of follow-up in the MSDS-trial.Nuklearmedizin. 2009; 48: 89-98
- Targeting vascular endothelial growth factor receptor in thyroid cancer: the intracellular and extracellular implications.Clin Cancer Res. 2010; 16: 778-783
- Emergency surgery in the era of molecular treatment of solid tumours.Lancet Oncol. 2009; 10: 157-163
Article info
Publication history
Accepted:
September 14,
2010
Identification
Copyright
© 2010 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
