Surgical management of papillary thyroid carcinoma with endotracheal infiltration

Abstract

To investigate the diagnosis and treatment of papillary thyroid carcinoma with endotracheal infiltration. Clinical data of 12 patients treated from January 1999 to December 2006 were retrospectively analyzed. Six patients received tracheal partial resection-sternocleidomastoid musculoperiosteal flap reconstruction (group A). Six patients received tracheal sleeve resection-end to end anastomosis (group B). Ten patients had the symptoms which indicated the tracheal invasion. Endotracheal focuses were detected in the region from 2 cm to 4 cm under glottis by endoscopy and positive rate of smear biopsy was 33%. Positive rate of CT scan was 92%. Mean diameter of carcinoma focus was 3.8 cm (from 3 cm to 7 cm), and mean number of tracheal ring resected was 4. For group A, even 7 rings were resected, and the longest longitude and latitude was 7 cm and 3 cm, respectively. For group B, the greatest number of rings resected was 4. Incidence rate of perioperative complication and mortality was 58% and 0%, respectively. Mean duration of follow-up was 49 months. One patient died of local recurrence, 1 patient died of lung metastasis. Two patients with tumor recurrence were also alive. For group A, extubation was successful in all patients. Comprehensive use of diagnostic methods, especially MRI, will give detailed information for operation. Tracheal partial resection-sternocleidomastoid musculoperiosteal flap reconstruction and tracheal sleeve resection-end to end anastomosis are safe and useful methods to reconstruct the defects caused by tracheal operation.