Int J Thyroidol.  2018 Nov;11(2):99-108. 10.11106/ijt.2018.11.2.99.

Surgical Treatment in Locally Advanced Thyroid Cancer – Trachea, Larynx, Esophagus Invasion Management

• Lee GH
• Kang JY

• KMID: 2448979
• DOI: http://doi.org/10.11106/ijt.2018.11.2.99

Abstract

Most thyroid cancers are well-differentiated cancers and have a very good prognosis. About 10% of thyroid cancer, however, invades the surrounding tissues, causing local recurrence and distant metastasis, and eventually affecting survival rate. In locally advanced thyroid cancers, the invasion of trachea, larynx and esophagus, can be occurred by primary tumor and may also result in lymph nodes metastasis. Surgical resection is still mainstay for the treatment of locally advanced thyroid cancer. The main purpose of the surgical resection is to eliminate the cancer completely, therefore, it can cause many complications such as dysfunction of the larynx, trachea and esophagus. It can have a serious effect on the quality of life, therefore there is still controversy on the extent of the surgery. The authors compare and analyze the opinions which were already discussed in the literatures published so far. These will help to select the surgical method.

Keyword

Locally advanced thyroid cancer; Larynx; Trachea; Esophagus

MeSH Terms

Esophagus*
Larynx*
Lymph Nodes
Methods
Neoplasm Metastasis
Prognosis
Quality of Life
Recurrence
Survival Rate
Thyroid Gland*
Thyroid Neoplasms*
Trachea*

Figure

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  Fig. 1 The staging system for papillary carcinoma of the thyroid invading the trachea, based on the histopathologic extent of invasion. (Adapted from 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(8): 866-70.)

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  Fig. 2 Five stages of aerodigestive tract involvement by invasive well-differentiated thyroid carcinoma. (Adapted from McCaffrey JC. Aerodigestive tract invasion by well-differentiated thyroid carcinoma: diagnosis, management, prognosis, and biology. Laryngoscope 2006;116(1): 1-11.)

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  Fig. 3 Tracheal window resection and sternocleidomastoid myoperiosteal flap.

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  Fig. 4 Trough method and tracheotomy.

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  Fig. 5 Mechanisms of local invasion of thyroid cancer. (A) Two examples of laryngeal invasion by a thyroid tumor. Direct invasion of the thyroid cartilage is shown on the left. Invasion of the paraglottic space by a thyroid tumor wrapping around the posterior edge of the thyroid cartilage is shown on the right and in the cross-sectional insert. (B) Example of a large thyroid carcinoma invading the pyriform sinus and pharynx by posterior extension around the thyroid cartilage as well as through the substance of the thyroid cartilage. (C) Invasion of the recurrent laryngeal nerve, tracheal wall, and esophagus by extension of thyroid carcinoma from a paratracheal lymph node. (D) Limited anterior tracheal invasion by thyroid carcinoma. Insert on right shows resection with a tracheal window; a "shave" excision in this case would leave behind intraluminal tumor. (Adapted from McCaffrey TV, Bergstralh EJ, Hay ID. Locally invasive papillary thyroid carcinoma: 1940-1990. Head Neck 1994;16(2):165-72.)

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  Fig. 6 Surgical algorithm for management of invasive well-differentiated thyroid carcinoma. (Adapted from McCaffrey JC. Aerodigestive tract invasion by well-differentiated thyroid carcinoma: diagnosis, management, prognosis, and biology. Laryngoscope 2006; 116(1):1-11.)

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