Is thyroid excision mandatory with laryngectomy in carcinoma larynx?

Surendra Singh Baghel,Namita Verma,Pawan Singhal,Man Prakash Sharma,Rajeev Yadav,Sunita Agarwal,D P Gupta,Ritu Sehra

doi:10.1186/s12885-020-07205-5

Abstract

BackgroundAdvanced stage operable cancers of larynx are treated with total laryngectomy including thyroid resection in most of the cases, which may expose patient to hypothyroidism and hypoparathyroidism. The requirement of thyroidectomy during Total Laryngectomy is controversial.MethodsA cross sectional observational study was set out to review preoperative clinical and radiological assessment; intraoperative and histopathological findings; and follow-up data to predict thyroid gland invasion in the setting of squamous cell carcinoma of the Larynx.Results11 (16%) out of 69 patients had thyroid gland involvement on histopathological examination with mean age 63 years. Out of these 11 cases, 8 (72%) underwent primary total laryngectomy. 90% patients with thyroid gland involvement were male. 9 cases with thyroid gland involvement were staged as T4a preoperatively.ConclusionInvasion of thyroid gland by laryngeal cancer is uncommon. Unnecessary hemithyroidectomies lead to hypothyroidism and hypoparathyroidism. The study points out the clear indications of thyroid excision in patients undergoing total laryngectomy. We can suggest that total thyroidectomy should be done with total laryngectomy in cases which have gross clinical, radiological or intraoperative thyroid gland involvement, subglottic extension and thyroid cartilage invasion. This can save the patients from the brunt of unnecessary morbid hypothyroidism and hypoparathyroidism.

Highlights

Advanced stage operable cancers of larynx are treated with total laryngectomy including thyroid resection in most of the cases, which may expose patient to hypothyroidism and hypoparathyroidism
Ipsilateral hemithyroidectomy or total thyroidectomy are considered mandatory for all patients undergoing total laryngectomy (TL) for squamous cell carcinoma (SCC) of the larynx
All biopsy proven cases of squamous cell carcinoma of larynx were subjected to total laryngectomy with hemi or total thyroidectomy, with or without partial pharyngectomy and the tissue samples were sent for histopathological examination

Summary

Introduction

Advanced stage operable cancers of larynx are treated with total laryngectomy including thyroid resection in most of the cases, which may expose patient to hypothyroidism and hypoparathyroidism. Ipsilateral hemithyroidectomy or total thyroidectomy are considered mandatory for all patients undergoing total laryngectomy (TL) for squamous cell carcinoma (SCC) of the larynx. This is because the anatomic position of the thyroid gland renders it vulnerable to involvement in advanced laryngeal cancers. It is well documented that patients are subjected to hypothyroidism as a consequence of head and neck cancer operations, especially for laryngeal carcinoma. Patients are at risk for complications of thyroidectomy as well as risks for laryngectomy and neck dissection, when thyroid gland is included in surgery for laryngeal carcinoma. This study examines preoperative clinical, radiological and histopathologic characteristics that can be used to predict thyroid gland invasion in the setting of SCC of the Larynx

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Results

Discussion

Conclusion