The management and prognosis of laryngotracheal invasion by well-differentiated thyroid carcinoma

Abstract

To explore the treatment and prognosis on patients with laryngotracheal invasion by well-differentiated thyroid carcinoma (DTC). Eighty-six patients treated for DTC with laryngotracheal invasion between 1976 and 1996, from Beijing Chaoyang Hospital and Cancer Hospital, Chinese Academy of Medical Sciences, were retrospectively analyzed. The different kinds of surgical modalities were performed according to the extent of laryngotracheal invasion by DTC, including shave excision (39 cases), tracheal window resection (11 cases), circumferential sleeve resection (8 cases), total laryngectomy (2 cases) and incomplete tumor resection (26 cases). Some patients received postoperative radiotherapy. Survival was evaluated using the Kaplan-Meier method. (1) Thirty-nine patients with laryngotracheal invasion were treated with shave excision, the 5- and 10-year survival rates were 92.3% (36/39) and 75.9% (22/29), respectively. Nine patients received postoperative radiotherapy, 30 patients didn't received postoperative radiotherapy. After a shave excision, the differences of 5- and 10-year survival rates between the irradiated and nonirradiated patients were not statistically significant (P >0.05). (2) Twenty-one patients underwent radial excision for intraluminal involvement extending through the laryngotracheal cartilage, including circumferential sleeve resection, tracheal window resection and total laryngectomy, the survival rate was 85.7% (18/21) for five years and 53.9% (7/13) for ten years. Eleven patients received postoperative radiotherapy, 10 patients didn't received postoperative radiotherapy. After a radial excision, the differences of 5- and 10-year survival rates between underwent irradiated and nonirradiated patients were not statistically significant (P >0.05). (3) For the 26 patients receiving the incomplete resection, the 5- and 10-year survival rates were 50.0% (13/26) and 19.2% (5/26), respectively. For 9 patients receiving postoperative radiotherapy, the 5- and 10-year survival rates were 77.8% (7/9) and 55.6% (5/9), respectively. 17 patients did not received postoperative radiotherapy, the 5-year survival rate was 35.5% (6/17). No patient survived for ten years. Tumors with minimal invasion could be treated successfully by shaving tumor from the aerodigestive tract. Intraluminal involvement extending through the laryngotracheal cartilage should be resected completely to prevent complications, such as airway hemorrhage or suffocation, and markedly improve the survival for patients with invasive DTC.