SURGICAL-MANAGEMENT OF THYROID-CANCER INVADING THE AIRWAY

Background: Locally advanced thyroid cancer invading the tracheal cart ilage represents a difficult treatment dilemma during thyroidectomy. M ethods: A retrospective chart review was performed to determine the re sults of laryngotracheal resection or tracheal cartilage shave with ad juvant radiotherapy in patients with locally advanced thyroid cancer i nvading the upper airway. Results: Of 597 patients undergoing thyroide ctomy for thyroid cancer, 40 were found to have laryngotracheal invasi on. Thirty-five patients with superficial invasion underwent cartilage shave procedures with adjuvant radiotherapy; five with full-thickness invasion underwent radical resection, including tracheal sleeve resec tion (n = 3) or total laryngectomy (n = 2). Histologic subtypes includ ed papillary (n = 32), follicular (n = 2), Hurthle cell (n = 1), medul lary (n = 3), and anaplastic (n = 2). Of the cartilage shave group, 25 are currently alive with no evidence of disease at a mean follow-up o f 81 months (range 1-290), Six developed isolated local/regional recur rence and were managed with total laryngectomy (n = 1), tracheal resec tion (n = 1), cervical lymphadenectomy (n = 1), or repeat radiotherapy (n = 3). All six patients remain free of disease at a mean follow-up of 5 years. Of those who underwent initial laryngotracheal resection, four remain free of disease at a mean follow-up of 5 years. The rates of 10-year disease-free survival and overall survival for all patients were 47.9% (95% confidence interval [CI] 24.8, 71.0) and 83.9% (95% C I 70.3, 97.5), respectively. Conclusions: These data suggest that adeq uate management of thyroid cancer with laryngotracheal invasion can be achieved with a more conservative surgical approach and adjuvant radi otherapy, reserving more radical resections for extensive primary lesi ons or locally recurrent disease.