Surgical treatment for well-differentiated thyroid carcinoma invading the larynx,trachea,esophagus and hypopharynx

Abstract

Objective:To explore the surgical treatment for well-differentiated thyroid carcinoma(WDTC) invading the larynx,trachea,esophagus and hypopharynx. Methods: Primary tumor resection was performed in 17 patients with advanced WDTC.All the 17 cases had laryngotracheal involvement and received different kinds of surgical treatment: including 14 receiving local shaving-off,wedge tracheal resection with direct suture,window tracheal resection with sternocleidomastoid myoperiosteous flap reconstruction,sleeve tracheal resection with tracheal anastomosis or tracheal reconstruction by forearm free skin flap,and 3 receiving total laryngectomy or near-total laryngectomy. Eleven cases with esophagus and hypopharynx involvement received muscular layer resection or esophageal and hypopharynx partial resection with pectoralis major myocutaneous flap reconstruction. For 12 cases with recurrent laryngeal nerve involvement,9 were treated by nerve decompression,nerve resection combined with one-stage arytenoid within-shift and/or recurrent laryngeal nerve transposition,3 by simple laryngectomy. Results: The patients were followed up for 1 to 12 years. Sixteen patients survived and one died of tumor metastasis. The 5-year survival rate was 93.3%; the post-operation complication rate was 23.5%.Tumor relapses were found in 2 cases who had undergone local shaving-off or partial cervical trachea resection. The voice quality of the 9 patients receiving recurrent laryngeal nerve decompression or voice rehabilitation was greatly improved,and 5 of them had normal voice. Conclusion: The curative rate and quality of life of WDTC patients with extrathyroidal extension can be improved by one-stage resection and reconstruction. Operation modes should be chosen according to the location, involvement of tumor, the invasion of recurrent laryngeal nerve and the disease course. Operation is invasive and reconstruction is a complicated process, with many complications.