The Surgical Treatment of Locally Invasive Thyroid Papillary Carcinoma

Kim, Jae Won; Choi, Jeong Seok; Yoon, Seok Young; Jung, Yoon Gun; Kim, Young Mo

Abstract

BACKGROUND AND OBJECTIVES
Thyroid papillary carcinoma usually progresses slowly and invades the surrounding tissues infrequently. About 10% of thyroid papillary carcinoma takes to local invasion that include larynx, pharynx, esophagus, and trachea. However, when invasion occurs, it becomes the source of significant morbidity and mortality to the patient. The main cause of death in thyroid papillary carcinoma is inappropriate treatment of local invasion. This study was designed to investigate the frequency and structure of local invasion, type of surgical treatment, complication and recurrence of locally invasive thyroid papillary carcinoma.
SUBJECTS AND METHOD
Between August 1996 and July 2004, 114 patients were diagnosed with thyroid papillary carcinoma and were treated surgically at the Department of Otorhinolaryngology-head & neck surgery, Inha Univ. Hospital. Preoperative evaluation included needle aspiration biopsy, thyroid function test, computerized tomography and/or magnetic resonance imaging. Study was done retrospectively.
RESULTS
Local invasion in thyroid papillary carcinoma was observed in 24% (27/114) of the thyroid papillary carcinoma. The most common invasion site was the recurrent laryngeal nerve. Total thyroidectomy was performed in all patients and was combined with radical procedures that included laryngectomy, pharyngectomy or with conservative procedures that included tracheal shaving and so on. Locoregional recurrence was observed in 19% of the cases and the most common site of local invasion was cervical lymph node. One case (4%) of patients died of locoregional recurrence.
CONCLUSION
Thyroid papillary carcinoma frequently invades the surrounding structure. We believe that precise preoperative evaluation and treatment including primary resection specific to preoperative evaluation, the management of cervical lymph node metastasis and postoperative radioactive iodine therapy may all contribute to decreasing the mortality and morbidity of locally invasive thyroid papillary carcinoma.