Thyroid cancers with laryngotracheal invasion.
OBJECTIVE
Management of thyroid cancers with laryngotracheal invasion is controversial.


METHODS
A retrospective analysis of our database found 69 patients (38 females, mean age 59.6 ± 11.6) between March 1995 and July 2010; of them 42 (61%) were managed by non-resectional methods due to the extensive airway or regional involvement, severe co-morbidities, diffuse metastases or patient's preference. Segmental airway resection was performed in 27 (39%) patients; concurrent with thyroidectomy in 17 (Immediate group (IG)), and as a delayed procedure in 10 referred patients (Delayed group (DG)), who had previously undergone thyroidectomy with conservative airway management, like shaving procedures. Follow-up was completed in 81% of patients with a mean duration of 30 months.


RESULTS
Tracheal or laryngotracheal resection and reconstruction was performed in 18, laryngectomy in eight and pharyngolaryngectomy in one patient. There were two anastomotic dehiscence (11.1%), one resulted in mortality (3.7%). One or a combination of bronchoscopic core-out, laser, tracheostomy and stent placement was performed in 42 non-resected patients with two mortalities (4.7%). Overall 1-, 2-, 3- and 5-year survival was 85, 85, 68 and 49% in resected group, as well as 56, 46, 40 and 31% in non-resected group (P = 0.049), respectively. Among resected group, the overall 1-, 2-, 3- and 5-year survival was 92, 92, 76 and 61% in the IG as well as 75, 75, 56 and 28% in the DG (P = 0.43).


CONCLUSIONS
Complete segmental airway resection during or even after thyroidectomy could be safely performed, might be curative and may be associated with improved survival.
Tracheal Diseases Research Center, NRITLD (National Research Institute of Tuberculosis and Lung Diseases), Shahid Beheshti University of Medical Sciences, Tehran, Iran. mbshadmehr@yahoo.com
Mohammad Behgam
MB
Shadmehr
Roya
R
Farzanegan
Mahdi
M
Zangi
Alireza
A
Mohammadzadeh
Kambiz
K
Sheikhy
Saviz
S
Pejhan
Abolghasem
A
Daneshvar
Azizollah
A
Abbasidezfouli
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007825:Laryngectomy / Q000009:adverse effects / Q000379:methods; D007830:Larynx / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010611:Pharyngectomy / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods; D014132:Trachea / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult