Surgical management of thyroid cancer invading the airway

Locally advanced thyroid cancer invading the tracheal cartilage represents a difficult treatment dilemma during thyroidectomy. A retrospective chart review was performed to determine the results of laryngotracheal resection or tracheal cartilage shave with adjuvant radiotherapy in patients with loca...

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Veröffentlicht in:Annals of surgical oncology 1997-07, Vol.4 (5), p.403-408
Hauptverfasser: McCarty, T M, Kuhn, J A, Williams, Jr, W L, Ellenhorn, J D, O'Brien, J C, Preskitt, J T, Lieberman, Z H, Stephens, J, Odom-Maryon, T, Clarke, K G, Wagman, L D
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container_end_page 408
container_issue 5
container_start_page 403
container_title Annals of surgical oncology
container_volume 4
creator McCarty, T M
Kuhn, J A
Williams, Jr, W L
Ellenhorn, J D
O'Brien, J C
Preskitt, J T
Lieberman, Z H
Stephens, J
Odom-Maryon, T
Clarke, K G
Wagman, L D
description Locally advanced thyroid cancer invading the tracheal cartilage represents a difficult treatment dilemma during thyroidectomy. A retrospective chart review was performed to determine the results of laryngotracheal resection or tracheal cartilage shave with adjuvant radiotherapy in patients with locally advanced thyroid cancer invading the upper airway. Of 597 patients undergoing thyroidectomy for thyroid cancer, 40 were found to have laryngotracheal invasion. Thirty-five patients with superficial invasion underwent cartilage shave procedures with adjuvant radiotherapy; five with full-thickness invasion underwent radical resection, including tracheal sleeve resection (n = 3) or total laryngectomy (n = 2). Histologic subtypes included papillary (n = 32), follicular (n = 2), Hurthle cell (n = 1), medullary (n = 3), and anaplastic (n = 2). Of the cartilage shave group, 25 are currently alive with no evidence of disease at a mean follow-up of 81 months (range 1-290). Six developed isolated local/regional recurrence and were managed with total laryngectomy (n = 1), tracheal resection (n = 1), cervical lymphadenectomy (n = 1), or repeat radiotherapy (n = 3). All six patients remain free of disease at a mean follow-up of 5 years. Of those who underwent initial laryngotracheal resection, four remain free of disease at a mean follow-up of 5 years. The rates of 10-year disease-free survival and overall survival for all patients were 47.9% (95% confidence interval [CI] 24.8, 71.0) and 83.9% (95% CI 70.3, 97.5), respectively. These data suggest that adequate management of thyroid cancer with laryngotracheal invasion can be achieved with a more conservative surgical approach and adjuvant radiotherapy, reserving more radical resections for extensive primary lesions or locally recurrent disease.
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A retrospective chart review was performed to determine the results of laryngotracheal resection or tracheal cartilage shave with adjuvant radiotherapy in patients with locally advanced thyroid cancer invading the upper airway. Of 597 patients undergoing thyroidectomy for thyroid cancer, 40 were found to have laryngotracheal invasion. Thirty-five patients with superficial invasion underwent cartilage shave procedures with adjuvant radiotherapy; five with full-thickness invasion underwent radical resection, including tracheal sleeve resection (n = 3) or total laryngectomy (n = 2). Histologic subtypes included papillary (n = 32), follicular (n = 2), Hurthle cell (n = 1), medullary (n = 3), and anaplastic (n = 2). Of the cartilage shave group, 25 are currently alive with no evidence of disease at a mean follow-up of 81 months (range 1-290). Six developed isolated local/regional recurrence and were managed with total laryngectomy (n = 1), tracheal resection (n = 1), cervical lymphadenectomy (n = 1), or repeat radiotherapy (n = 3). All six patients remain free of disease at a mean follow-up of 5 years. Of those who underwent initial laryngotracheal resection, four remain free of disease at a mean follow-up of 5 years. The rates of 10-year disease-free survival and overall survival for all patients were 47.9% (95% confidence interval [CI] 24.8, 71.0) and 83.9% (95% CI 70.3, 97.5), respectively. These data suggest that adequate management of thyroid cancer with laryngotracheal invasion can be achieved with a more conservative surgical approach and adjuvant radiotherapy, reserving more radical resections for extensive primary lesions or locally recurrent disease.</abstract><cop>United States</cop><pub>Springer Nature B.V</pub><pmid>9259967</pmid><doi>10.1007/bf02305553</doi><tpages>6</tpages></addata></record>
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subjects Adolescent
Adult
Aged
Aged, 80 and over
Cartilage
Cervix
Child
Child, Preschool
Disease-Free Survival
Female
Health risk assessment
Humans
Laryngectomy
Larynx - pathology
Larynx - surgery
Male
Middle Aged
Neoplasm Invasiveness
Prognosis
Radiation therapy
Respiratory tract
Retrospective Studies
Survival Rate
Thyroid cancer
Thyroid Neoplasms - mortality
Thyroid Neoplasms - pathology
Thyroid Neoplasms - surgery
Thyroidectomy
Trachea - pathology
Trachea - surgery
title Surgical management of thyroid cancer invading the airway
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