title: Surgical management of thyroid cancer invading the airway.
abstract: BACKGROUND
  Locally advanced thyroid cancer invading the tracheal cartilage represents a difficult treatment dilemma during thyroidectomy.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Surgery, City of Hope National Medical Center, Duarte, California 91010, USA.
authors.forename: T M
authors.initials: TM
authors.lastname: McCarty
authors.forename: J A
authors.initials: JA
authors.lastname: Kuhn
authors.forename: W L
authors.initials: WL
authors.lastname: Williams
authors.forename: J D
authors.initials: JD
authors.lastname: Ellenhorn
authors.forename: J C
authors.initials: JC
authors.lastname: O'Brien
authors.forename: J T
authors.initials: JT
authors.lastname: Preskitt
authors.forename: Z H
authors.initials: ZH
authors.lastname: Lieberman
authors.forename: J
authors.initials: J
authors.lastname: Stephens
authors.forename: T
authors.initials: T
authors.lastname: Odom-Maryon
authors.forename: K G
authors.initials: KG
authors.lastname: Clarke
authors.forename: L D
authors.initials: LD
authors.lastname: Wagman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007825:Laryngectomy; D007830:Larynx / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D013965:Thyroidectomy; D014132:Trachea / Q000473:pathology* / Q000601:surgery