title: Clinical outcome of different modes of resection in papillary thyroid carcinomas with laryngotracheal invasion.
abstract: OBJECTIVE
  The aim of this study is to evaluate the outcome of different modes of resection in papillary thyroid carcinoma (PTC) with laryngotracheal invasion.
  
  
  METHODS
  Sixty-four primary PTCs with laryngotracheal invasion between 1964 and 2003 were retrospectively analyzed (17 men and 47 women; mean age, 61.6 years; mean follow-up, 92.3 months). Thirteen curative resections included six pharyngolaryngoesophagectomies, two total laryngectomies, and five circumferential resections (complete surgery). Eighteen patients who were candidates for curative resection refused to undergo complete surgery to avoid functional impairment, especially laryngeal function (incomplete surgery). Thirty-three patients with minimal invasion underwent shave or partial resection (conservative surgery). Clinical outcomes were compared between the three groups. The influence of different types of surgery and invasion was also evaluated by Cox proportional hazard analysis.
  
  
  RESULTS
  Three (23.1%) complete, 17 (94.4%) incomplete, and 4 (13.8%) conservative surgery patients died of disease (P < 0.0001). The 10-year disease-specific survival (Kaplan-Meier) in complete, incomplete, and conservative surgery patients were 62.9, 11.1, and 87.7%, respectively (log rank test, P < 0.0001). Incomplete surgery related to worse prognosis [p < 0.0001; hazard ratio (HR), 12.9) than complete or conservative surgery. Tracheal deep invasion (p = 0.0019, HR 7.6) and larynx invasion (p < 0.0001, HR 9.9) related to worse prognosis than minimal invasion.
  
  
  CONCLUSIONS
  Curative resection improves clinical outcomes in PTCs with laryngotracheal invasion. Conservative resection for minimal invasion also can achieve favorable prognosis. The degree of tumor invasion is significantly related to survival.
authors.affiliation: Department of General Surgery, Yokohama City University, 3-9 Fukuura, Kanazawa-ku Yokohama, Kanagawa 236-0004, Japan. Wadan523@aol.com
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Wada
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Nakayama
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Masudo
authors.forename: Nobuyasu
authors.initials: N
authors.lastname: Suganuma
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Rino
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010611:Pharyngectomy; D012189:Retrospective Studies; D013964:Thyroid Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods*; D016896:Treatment Outcome