title: A Novel Surgical Technique for Thyroid Cancer with Intra-Cricotracheal Invasion: Windmill Resection and Tetris Reconstruction.
abstract: The most effective treatment for thyroid cancer (TC) invading into the larynx and trachea is a complete surgical resection of the tumor, but currently employed techniques are less than ideal. We report a novel surgical technique, which we named Windmill resection and Tetris reconstruction, for patients with TC invading into the laryngeal lumen. We treated eight cases of TC with invasion into the laryngeal lumen by Windmill resection and Tetris reconstruction. We analyzed complications, clinical data, and pathological findings for all patients. Patients included one man and seven women (mean age 69 ± 10 years). Histopathology of TC indicated papillary cancer in five patients, poorly differentiated cancer in one patient, anaplastic cancer in one patient, and squamous cell carcinoma in one patient. Unilateral recurrent laryngeal nerve (RLN) palsy was confirmed preoperatively by laryngoscope in four patients, and none had bilateral RLN palsy. All patients underwent Windmill resection and Tetris reconstruction along with total thyroidectomy (three patients), subtotal thyroidectomy (three patients), and lobectomy (two patients). Neck dissection was performed in all patients. The average resected length of the larynx and trachea was 29 ± 6 mm. Air leakage at the suture line occurred in three patients; two required further surgery, while the third was closed by insertion of a Penrose drain. Postoperative RLN palsy occurred in five patients. Aspiration was observed in two patients and resolved within 4 weeks. Pneumonia, atelectasis, and pleural effusion occurred in some patients. No other complications, including hemorrhage, wound infection, or airway stenosis, occurred. There was no postoperative mortality and no recurrence at the anastomotic site. Two patients underwent permanent tracheostomy due to permanent bilateral RLN palsy. Two patients, one with anaplastic cancer and the other with poorly differentiated cancer, recurred 13 and 21 months after surgery, while patients with papillary thyroid cancer had no local recurrence. Importantly, laryngeal functions such as phonation and swallowing were preserved in all patients. This novel surgical technique may be as effective as window resection of the larynx for local control of TC and contributes to the quality of life of patients by resulting in a less unsightly surgical wound.
authors.affiliation: Noguchi Thyroid Clinic and Hospital Foundation, 6-33, Noguchi-Nakamachi, Beppu, Oita, 874-0932 Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Enomoto
authors.affiliation: Noguchi Thyroid Clinic and Hospital Foundation, 6-33, Noguchi-Nakamachi, Beppu, Oita, 874-0932 Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Uchino
authors.affiliation: Noguchi Thyroid Clinic and Hospital Foundation, 6-33, Noguchi-Nakamachi, Beppu, Oita, 874-0932 Japan.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Noguchi
authors.affiliation: Noguchi Thyroid Clinic and Hospital Foundation, 6-33, Noguchi-Nakamachi, Beppu, Oita, 874-0932 Japan.
authors.forename: Yukie
authors.initials: Y
authors.lastname: Enomoto
authors.affiliation: Noguchi Thyroid Clinic and Hospital Foundation, 6-33, Noguchi-Nakamachi, Beppu, Oita, 874-0932 Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Noguchi
keywords: Cricotracheal invasion; Laryngeal invasion; Tetris; Thyroid cancer; Tracheal invasion