Surgery on the cervicovisceral axis for invasive thyroid cancer

Background and aims: Invasion of the cervicovisceral axis (i.e., larynx tra chea esophagus) by thyroid cancers still poses a surgical challenge. Patien ts and methods: Between November 1994 and October 1999, all patients who un derwent surgery at this institution for differentiated (DTC) or medullary ( MTC) thyroid carcinoma invading the cervicovisceral axis were recruited int o this study. Results: The cervicovisceral axis was invaded in 34 consecuti ve patients (19 DTC, 15 MTC). Of these, 20 patients underwent cervicoviscer al resections. These resections were performed less often in MTC than in DT C patients (20% versus 89%; P <0.0001). Full-thickness invasion was present in 3 patients (2 DTC, 1 MTC). In the 20 resectional patients, tracheal wed ge resection was the most common procedure followed by extramucosal esophag eal resection. Surgical mortality was nil. There were five major complicati ons, most of which occurred in either lateral tracheal or high-risk combine d laryngo-tracheoesophageal resections. Conclusion: The surgical approach t o invasive thyroid carcinoma must balance surgical morbidity against the po tential benefits of cervicovisceral resection. Individual factors must be c onsidered, such as patient age and co-morbidity, the extent and nature of t he tumor, and quality-of-life issues, Lateral resection of the trachea may cause significant tracheal instability and morbidity and, thus, be inferior to segmental tracheal resection.