Management of advanced thyroid carcinoma with laryngotracheal invasion

Year 2017, Volume: 27 Issue: 3, 115 - 121, 25.07.2017

Ayşegül Batıoğlu Karaaltın Murat Haydar Yener Mehmet Yılmaz Nesrettin Fatih Turgut Muhammed Pamukçu Harun Cansız

Abstract

Objectives: This study aims to evaluate the management of advanced thyroid carcinoma with extra-thyroidal extension. Patients and Methods: The study included 58 patients 26 males, 32 females; mean age 45.1±8.3 years; range 24 to 72 years who were referred from general surgery or other otolaryngology departments and had undergone surgery for T4a well-differentiated thyroid carcinoma or T4b anaplastic carcinoma between January 2007 and January 2011 with a minimum of five years of follow-up. The patients with laryngotracheal invasion were divided into two groups according to type of surgery. Patterns of invasion and techniques of surgical resection were evaluated. Results: Of the patients in group 1 n=24 , total thyroidectomy was performed in all 100% , partial laryngectomy in six 10.4% , tracheal resection in eight 13% , and tracheal window resection in 16 27% , and the free margins were verified by frozen section. Patients in group 2 n=34 were performed total thyroidectomy 100% by shaving the tumor off the underlying cartilage or skeletonizing laryngotracheal segments. During the follow-up period, one patient died because of carotid involvement and four patients died because of local recurrence. Conclusion: The results of this study suggest that the depth of the invasion and postoperative morbidity should be considered when choosing a surgical approach for patients with advanced thyroid carcinoma with extra-thyroidal extension. Also, patients who undergo tumor shaving should be followed-up closely.

Keywords

Extra-thyroidal extension, segmental laryngotracheal resection, thyroid carcinoma

Larengotrakeal invazyonlu ileri tiroid karsinomunun tedavisi

Abstract

Amaç: Bu çalışmada ekstra tiroidal uzantılı ileri tiroid karsinomunun tedavisi değerlendirildi.Hastalar ve Yöntemler: Çalışmaya genel cerrahi veya diğer kulak-burun-boğaz bölümlerinden sevk edilen ve Ocak 2007 - Ocak 2011 tarihleri arasında T4a iyi diferansiye tiroid karsinomu veya T4b anaplastik karsinomu nedeniyle cerrahi geçiren, en az beş yıl takip edilen 58 hasta 26 erkek, 32 kadın; ort. yaş 45.1±8.3 yıl; dağılım 24-72 yıl dahil edildi. Larengotrakeal invazyonu olan hastalar cerrahi türüne göre iki gruba ayrıldı. İnvazyon paternleri ve cerrahi rezeksiyon teknikleri değerlendirildi.Bulgular: Grup 1’deki hastaların n=24 tamamına %100 total tiroidektomi, altısına %10.4 parsiyel larenjektomi, sekizine %13 trakeal rezeksiyon ve 16’sına %27 trakeal pencere rezeksiyonu uygulandı; serbest marjinler dondurulmuş kesit ile doğrulandı. Grup 2’deki hastalara n=34 tümörü alttaki kıkırdaktan kazıyarak veya larengotrakeal segmentleri iskeletleştirerek total tiroidektomi %100 uygulandı. Takip dönemi sırasında, bir hasta karotis tutulumu ve dört hasta lokal rekürens nedeniyle kaybedildi.Sonuç: Bu çalışmanın bulguları ekstra tiroidal uzantılı ileri tiroid karsinomlu hastalar için cerrahi bir yaklaşım seçilirken invazyon derinliğinin ve ameliyat sonrası morbiditenin dikkate alınması gerektiğini ortaya koymaktadır. Ayrıca, tümör kazıması geçiren hastalar yakından takip edilmelidir

Keywords

Ekstra tiroidal uzantı, segmental larengotrakeal rezeksiyon, tiroid karsinomu

References

• Ortiz S, Rodríguez JM, Soria T, Pérez-Flores D, Piñero A, Moreno J, et al. Extrathyroid spread in papillary carcinoma of the thyroid: clinicopathological and prognostic study. Otolaryngol Head Neck Surg 2001;124:261-5.
• Andersen PE, Kinsella J, Loree TR, Shaha AR, Shah JP. Differentiated carcinoma of the thyroid with extrathyroidal extension. Am J Surg 1995;170:467-70.
• Compton CC, Byrd DR, Garcia-Aguilar J, Kurtzman SH, Olawaiye A, Washington MK. AJCC cancer staging atlas: a companion to the seventh editions of the AJCC cancer staging manual and handbook. Berlin: Springer Science & Business Media; 2012.
• Hu A, Clark J, Payne RJ, Eski S, Walfish PG, Freeman JL. Extrathyroidal extension in well-differentiated thyroid cancer: macroscopic vs microscopic as a predictor of outcome. Arch Otolaryngol Head Neck Surg 2007;133:644-9.
• Clain JB, Scherl S, Dos Reis L, Turk A, Wenig BM, Mehra S, et al. Extrathyroidal extension predicts extranodal extension in patients with positive lymph nodes: an important association that may affect clinical management. Thyroid 2014;24:951-7.
• Ito Y, Tomoda C, Uruno T, Takamura Y, Miya A, Kobayashi K, et al. Minimal extrathyroid extension does not affect the relapse-free survival of patients with papillary thyroid carcinoma measuring 4 cm or less over the age of 45 years. Surg Today 2006;36:12-8.
• Leboulleux S, Rubino C, Baudin E, Caillou B, Hartl DM, Bidart JM, et al. Prognostic factors for persistent or recurrent disease of papillary thyroid carcinoma with neck lymph node metastases and/or tumor extension beyond the thyroid capsule at initial diagnosis. J Clin Endocrinol Metab 2005;90:5723-9.
• Tollefsen HR, Decosse JJ, Hutter RV. Papillary carcinoma of the thyroid. A clinical and pathological study of 70 fatal cases. Cancer 1964;17:1035-44.
• McCarty TM, Kuhn JA, Williams WL Jr, Ellenhorn JD, O’Brien JC, Preskitt JT, et al. Surgical management of thyroid cancer invading the airway. Ann Surg Oncol 1997;4:403-8.
• Djalilian M, Beahrs OH, Devine KD, Weiland LH, DeSanto LW. Intraluminal involvement of the larynx and trachea by thyroid cancer. Am J Surg 1974;128:500-4.
• Tovi F, Goldstein J. Locally aggressive differentiated thyroid carcinoma. J Surg Oncol 1985;29:99-104.
• Honings J, Stephen AE, Marres HA, Gaissert HA. The management of thyroid carcinoma invading the larynx or trachea. Laryngoscope 2010;120:682-9.
• Grillo HC, Zannini P. Resectional management of airway invasion by thyroid carcinoma. Ann Thorac Surg 1986;42:287-98.
• Ishihara T, Kobayashi K, Kikuchi K, Kato R, Kawamura M, Ito K. Surgical treatment of advanced thyroid carcinoma invading the trachea. J Thorac Cardiovasc Surg 1991;102:717-20.
• Segal K, Abraham A, Levy R, Schindel J. Carcinomas of the thyroid gland invading larynx and trachea. Clin Otolaryngol Allied Sci 1984;9:21-5.
• Cody HS, Shah JP. Locally invasive, well-differentiated thyroid cancer. 22 years' experience at Memorial Sloan- Kettering Cancer Center. Am J Surg 1981;142:480-3.
• Breaux GP Jr, Guillamondegui OM. Treatment of locally invasive carcinoma of the thyroid: how radical? Am J Surg 1980;140:514-7.
• Hay ID, Bergstralh EJ, Goellner JR, Ebersold JR, Grant CS. Predicting outcome in papillary thyroid carcinoma: development of a reliable prognostic scoring system in a cohort of 1779 patients surgically treated at one institution during 1940 through 1989. Surgery 1993;114:1050-7.
• Hay ID, Grant CS, Taylor WF, McConahey WM. Ipsilateral lobectomy versus bilateral lobar resection in papillary thyroid carcinoma: a retrospective analysis of surgical outcome using a novel prognostic scoring system. Surgery 1987;102:1088-95.
• Shin DH, Mark EJ, Suen HC, Grillo HC. Pathologic staging of papillary carcinoma of the thyroid with airway invasion based on the anatomic manner of extension to the trachea: a clinicopathologic study based on 22 patients who underwent thyroidectomy and airway resection. Hum Pathol 1993;24:866-70.
• Nishida T, Nakao K, Hamaji M. Differentiated thyroid carcinoma with airway invasion: indication for tracheal resection based on the extent of cancer invasion. J Thorac Cardiovasc Surg 1997;114:84-92.
• Chiacchio S, Lorenzoni A, Boni G, Rubello D, Elisei R, Mariani G. Anaplastic thyroid cancer: prevalence, diagnosis and treatment. Minerva Endocrinol 2008;33:341-57.
• Smallridge RC, Copland JA. Anaplastic thyroid carcinoma: pathogenesis and emerging therapies. Clin Oncol (R Coll Radiol) 2010;22:486-97.
• Kebebew E. Anaplastic thyroid cancer: rare, fatal, and neglected. Surgery 2012;152:1088-9.
• Wendler J, Kroiss M, Gast K, Kreissl MC, Allelein S, Lichtenauer U, et al. Clinical presentation, treatment and outcome of anaplastic thyroid carcinoma: results of a multicenter study in Germany. Eur J Endocrinol 2016;175:521-9.
• Haigh PI, Ituarte PH, Wu HS, Treseler PA, Posner MD, Quivey JM, et al. Completely resected anaplastic thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival. Cancer 2001;91:2335-42.