Resectional treatment for thyroid cancer with tracheal invasion - A long-term follow-up study

Hypothesis: Transmural invasion of the trachea by well-differentiated thyro id carcinomas is a locally advanced disease condition. It frequently causes deaths owing to airway obstruction. We hypothesized that resection of the invaded trachea followed by primary anastomosis provides the opportunity fo r cure. Design: A retrospective review study of medical records. Setting: The surgical department of a tertiary referral center. Patients: Eight patients with well-differentiated thyroid carcinomas, compl icated with tracheal invasion resulting in bleeding and airway obstruction, operated on by tracheal resection and immediate anastomosis, were included . Interventions: All patients received total thyroidectomy and neck lymph nod e dissection as well as segmental tracheal resection followed by primary re construction. Postoperative radioactive sodium iodine I 131 treatment and s uppression therapy with thyroxine were applied to all of them. Main Outcome Measure: Postoperative follow-up of serum levels of human thyr oglobulin and abnormal radioactive iodine I-131 from whole body scan. Results: Seven patients are alive. Of these patients, 5 had no evidence of disease; (3 had no evidence of cancer for more than 10 years' follow-up), 2 had regional lymph node metastasis, and 1 had lung metastases. The remaini ng patient had anastomotic site recurrence with airway obstruction and need ed tracheostomy to relieve strider. She was lost to follow-up 39 months aft er undergoing the initial operation. Conclusions: Patients with mucosal invasion of the trachea by well-differen tiated thyroid carcinomas should be treated by surgical resection followed by primary reconstruction when technically feasible. This facilitates posto perative care, and it is possible to achieve long-term survival with improv ement of the quality of life and possible cures.