Tracheal Shaving in the Thyroid Papillary Carcinoma with Airway Invasion

Kim, Seung Tae; Shim, Yoon Sang; Oh, Kyung Kyoon; Lee, Yong Sik; Park, Seok Jin; Park, Yoon Young; Choi, Jin Ho

Abstract

OBJECTIVES
We analyzed the outcome of trachea shaving in 20 patients with locally invasive thyroid papillary carcinoma.
MATERIALS AND METHODS
From Jan. 1992 to Jun. 1994, we treated surgically 205 patients with papillary thyroid carcinoma, of whom 41 revealed upper airway invasion and 20 were treated with the shaving method. The others were treated with window resection, circumferential resection, and total laryngopharyngectomy with free jejunal graft. Twenty patients who underwent the shaving procedure were followed up for 28 to 59 months (mean of 49.5 months) and were examined for the incidence of recurrence by way of physical examinations, elevated serum thyroglobulin, despite of the TSH suppression therapy, iodine whole body scan, and the endoscopic examination.
RESULTS
The rate of recurrence was 5% (one patient), and it was detected by the iodine whole body scan. The site of recurrence was the pyriform sinus and paraglottic space, so we performed partial laryngopharyngectomy.
CONCLUSION
In thyroid papillary carcinoma invading the upper airway, the extent of resection should be determined individually according to the extent of tumor invasion. If the adventitia of the trachea is only the invasion site, and a grossly complete resection is performed, the 'shaving' method may be sufficient. However, the window resection or the circumferential resection should be performed in more invasive cases. Our data suggest that the surgical method of resection may be determined individually, and surgeons who have flexible attitudes may have good results.