title: Thyroid cancer invading the airway: diagnosis and management.
abstract: BACKGROUND
  Aim of this study is to analyze outcome and the decision making process to approach airway invasion by thyroid tumors.
  
  
  METHODS
  Retrospective study of 30 years experience in thyroid surgery for cancer invading airway. Clinical records, surgical and pathology reports have been analyzed to assess which principles and procedural details are significant to facilitate efficient diagnosis, staging and treatment. Medical therapy was not evaluated.
  
  
  RESULTS
  Out of a consecutive series of 2165 thyroid cancer patients, T4a cancers are 303 (14%). Airway invasion was found in 141 (6.5%) cases. Well-differentiated pattern was determined in 110 (78%) while other histology was reported in 31 (22%). Airway-related symptoms have been recorded in 111 (78%) patients. Flexible bronchoscopy was performed in all patients. Rapidly evolving disease or non-resectable airway was found in 105 (74.5%) cases. Permanent tracheotomy was performed in 43 (30.5%) cases, airway lumen restoration with or without stenting in 39 (27.7%), laryngectomy in 8 (5.7%), segmental airway resection and reconstruction in 28 (19.9%). Perioperative mortality was recorded after palliative treatment only. In resected patients, completely radical surgery was not always achievable. All patients with positive margin after resection underwent adjuvant treatment and showed comparable survival to radical surgery patients after 5 years. Tumor relapse occurred in 8 (28.6%) cases (distant or locoregional). Patients with unresectable disease require treatment for symptoms relief but survival is poor.
  
  
  CONCLUSIONS
  Although some patients are currently referred with a severely advanced disease, the indication for tracheotomy, salvage procedures or supportive care has decreased over time. Resection is feasible for differentiated tumors with an overall good outcome.
authors.affiliation: General and Specialized Surgery, University of Perugia Medical School, "Santa Maria" Hospital, via T. di Joannuccio, 05100, Terni, Italy. Electronic address: nicolaavenia@libero.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Avenia
authors.affiliation: Thoracic Surgery Unit, University of Perugia Medical School, Loc. Sant'Andrea delle Fratte, 06134, Perugia, Italy. Electronic address: jacopovannucci@tiscali.it.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Vannucci
authors.affiliation: Thoracic Surgery Unit, University of Perugia Medical School, Loc. Sant'Andrea delle Fratte, 06134, Perugia, Italy. Electronic address: massimo.monacelli@gmail.com.
authors.forename: Massimo
authors.initials: M
authors.lastname: Monacelli
authors.affiliation: General and Specialized Surgery, University of Perugia Medical School, "Santa Maria" Hospital, via T. di Joannuccio, 05100, Terni, Italy. Electronic address: robertalucchini@alice.it.
authors.forename: Roberta
authors.initials: R
authors.lastname: Lucchini
authors.affiliation: General and Specialized Surgery, University of Perugia Medical School, "Santa Maria" Hospital, via T. di Joannuccio, 05100, Terni, Italy. Electronic address: apolis74@yahoo.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Polistena
authors.affiliation: Thoracic Surgery Unit, University of Perugia Medical School, Loc. Sant'Andrea delle Fratte, 06134, Perugia, Italy. Electronic address: stefanosantoprete@alice.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Santoprete
authors.affiliation: Thoracic Surgery Unit, University of Perugia Medical School, Loc. Sant'Andrea delle Fratte, 06134, Perugia, Italy. Electronic address: ro55e77apotenza@yahoo.it.
authors.forename: Rossella
authors.initials: R
authors.lastname: Potenza
authors.affiliation: Thoracic Surgery Unit, University of Perugia Medical School, Loc. Sant'Andrea delle Fratte, 06134, Perugia, Italy. Electronic address: marcoandolfi@hotmail.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Andolfi
authors.affiliation: Thoracic Surgery Unit, University of Perugia Medical School, Loc. Sant'Andrea delle Fratte, 06134, Perugia, Italy. Electronic address: fr_puma@yahoo.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Puma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000402:Airway Obstruction / Q000209:etiology* / Q000601:surgery*; D000066491:Clinical Decision-Making; D005260:Female; D006801:Humans; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D011183:Postoperative Complications; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000473:pathology* / Q000601:surgery*; D014139:Tracheostomy
keywords: Airway; Locally invasive; Multimodality; Surgery; Thyroid cancer; Trachea