Segmental laryngotracheal and tracheal resection for invasive thyroid carcinoma.
BACKGROUND
Laryngotracheal invasion worsens prognosis in patients with thyroid carcinoma. The extent of resection is controversial.


METHODS
We performed a retrospective study of patients with thyroid carcinoma and invasion of the larynx or trachea between 1964 and 2005.


RESULTS
Eighty-two patients, mean age 64 years and 50% female, underwent segmental airway resection. Differentiated carcinoma was present in 76% (62 of 82 patients), prior tracheal "shave" procedures in 40% (33 of 82 patients), transmural invasion in 58% (48 of 82 patients), and preoperative vocal cord paralysis in 35% (29 of 82 patients). There were 29 tracheal and 40 laryngotracheal resections (reconstruction group: 69 patients); 5 underwent laryngectomy, 7 cervical exenteration, and 1 tracheal resection after exenteration (salvage group: 13 patients). Operative mortality was 1.2% (1 of 82 patients) and anastomotic dehiscence 4.3% (3 of 69 patients). Tracheostomy was permanent in 4.3% (3 of 69 patients). Mean follow-up was 6.1 years. After reconstruction, mean survival was 9.4 years and 10-year survival was 40%; after salvage, these were 5.6 years and 15%, respectively. In differentiated carcinoma, thyroidectomy, immediate shave procedure, and delayed (mean, 67 months) resection of airway recurrence in 15 patients resulted in overall and disease-free survival of 13.1 and 5.1 years, respectively, compared with 17.9 and 14.6 years, respectively, after thyroidectomy and early airway resection in 11 patients. Airway symptoms, metastases at presentation, recurrent disease, and salvage operation were associated with decreased survival; airway resection early after thyroidectomy, complete resection, and well-differentiated tumors were associated with improved prognosis.


CONCLUSIONS
Segmental airway resection for invasive thyroid cancer is safe, preserves the voice, and relieves airway obstruction. Complete resection of laryngeal and tracheal invasion during or early after thyroidectomy is associated with improved survival.
Gaissert
Henning A
HA
Division of Thoracic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts 02114, USA. hgaissert@partners.org
Honings
Jimmie
J
Grillo
Hermes C
HC
Donahue
Dean M
DM
Wain
John C
JC
Wright
Cameron D
CD
Mathisen
Douglas J
DJ
D000368:Aged; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D013965:Thyroidectomy; D014132:Trachea / Q000601:surgery; D014134:Tracheal Neoplasms / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*