title: Evidence-based management of the thyroid gland during a total laryngectomy.
abstract: OBJECTIVE
  To propose an original experience-based reference framework for the management of the thyroid gland during a total laryngectomy in our institution. The steps were based on 1) the incidence and patterns of thyroid gland invasion (TGI), 2) preoperative and pathologic factors associated with TGI, and 3) the relationship between TGI and oncologic efficacy endpoints after treatment.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  We reviewed the records of 182 patients who had undergone a total laryngectomy with a total thyroidectomy or loboisthmectomy in our center.
  
  
  RESULTS
  Among 23 patients (12.6%), the thyroid gland was directly invaded by disease in 22 and by metastasis in one. Subglottic primary site was the only preoperative factor associated (P =.03). TGI was associated with pathological signs of anterior extralaryngeal invasive disease (thyroid cartilage transfixion, P = .002; cricothyroid membrane invasion, P < .0001; and prelaryngeal soft tissue infiltration, P < .0001) and ipsilateral VIb lymph node metastasis (P = .004). As expected, disease-free survival was significantly lower in patients with TGI (P = .04) and peristomal control was significantly reduced in patients with TGI (P = .038).
  
  
  CONCLUSIONS
  To our knowledge, this is the largest monocentric series of TGI specimens after a total laryngectomy for laryngeal neoplasms described to date. Focus must be placed on anteroinferior spread, which is likely to invade the cricothyroid membrane, because TGI is part of the extension of extralaryngeal cancer. We propose original experience-based management of thyroid management during a total laryngectomy to improve the level of accuracy of decision making during the surgical procedure whenever possible.
  
  
  METHODS
  4
authors.affiliation: Department of Head and Neck Oncology.
authors.forename: Philippe
authors.initials: P
authors.lastname: Gorphe
authors.affiliation: Department of Pathology, Gustave Roussy Institute, Villejuif, France.
authors.forename: Aïcha
authors.initials: A
authors.lastname: Ben Lakhdar
authors.affiliation: Department of Radiotherapy.
authors.forename: Yungan
authors.initials: Y
authors.lastname: Tao
authors.affiliation: Department of Head and Neck Oncology.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Breuskin
authors.affiliation: Department of Head and Neck Oncology.
authors.forename: François
authors.initials: F
authors.lastname: Janot
authors.affiliation: Department of Head and Neck Oncology.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Temam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D019317:Evidence-Based Medicine; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007822:Laryngeal Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck; D013961:Thyroid Gland / Q000473:pathology*
keywords: Laryngeal squamous cell carcinoma; extralaryngeal spread; thyroid gland invasion; thyroidectomy; total laryngectomy