Abstract
BackgroundSurgery remains the main treatment for locally advanced thyroid cancers invading the trachea, esophagus, and recurrent laryngeal nerve. However, extensive resection of such tumors can sometimes involve difficulties and may result in the deterioration of the patient’s quality of life. The surgeon should consider not only the patient’s prognosis but also the preservation of postoperative function.MethodsThis report describes a minimally invasive surgical procedure for recurrent poorly differentiated papillary thyroid carcinoma involving the trachea and esophagus. To decrease the potential for recurrent laryngeal nerve injuries and to preserve both the tracheal and esophageal blood supply, we adapted a transtracheal approach; the recurrent tumor was safely and completely removed without causing a dysfunction. After a tracheotomy to the right, the tumor was easily detected through the tracheostoma and delineated by palpation. The mucous membrane of the trachea was minimally incised along the right-hand border of the tumor and a mucosal flap was elevated. The left side of the trachea including the membranous wall and cartilage of the tracheal mucosa was maximally preserved, to maintain the vascular supply to the trachea. Finally, the membranous wall of the trachea was preserved to within one-third of the left-hand side. Furthermore, the risk of bleeding from major lateral vessels was reduced. A sternocleidomastoid muscle flap was elevated and inserted into the cavity resulting from the tumor resection and sutured between the esophagus and trachea. The membranous wall of the tracheal mucosa was also sutured submucosally.ResultsThe tumor was removed completely with the muscular layer of the esophagus without injury to the intact recurrent laryngeal nerve and lateral major vessels. The patient started oral nutritional intake on the first postoperative day and was discharged without any significant postoperative complications.ConclusionsThis new procedure for transtracheal resection for recurrent thyroid cancer involving the trachea and esophagus was useful and safe.
Highlights
Surgery remains the main treatment for locally advanced thyroid cancers invading the trachea, esophagus, and recurrent laryngeal nerve
The key point of this technique was to complete the procedure with potentially less risk of injury to the intact recurrent laryngeal nerve or the lateral major vessels
All the removed tissues were sent for histopathologic evaluation, and were found to be consistent with poorly differentiated thyroid carcinoma (Figure 2B)
Summary
Surgery remains the main treatment for locally advanced thyroid cancers invading the trachea, esophagus, and recurrent laryngeal nerve. The surgeon should consider the patient’s prognosis and the preservation of postoperative function. Surgery remains the mainstay for the treatment of locally advanced recurrent thyroid cancer. With complex recurrent thyroid cancer with recurrent laryngeal nerve palsy, dissection for the trachea and esophagus can be associated with significant morbidity, including dyspnea and dysphagia [1,2]. The morbidity from radical resection has led some surgeons to avoid curative treatments. Our objective was to perform minimally invasive surgery with transtracheal central neck dissection for recurrent thyroid cancer. There have been no reports regarding minimally invasive surgery for the treatment of recurrent thyroid cancer
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