Laryngotracheal Invasion Research Articles

Surgical management of thyroid cancer invading the airway.

Locally advanced thyroid cancer invading the tracheal cartilage represents a difficult treatment dilemma during thyroidectomy. A retrospective chart review was performed to determine the results of laryngotracheal resection or tracheal cartilage shave with adjuvant radiotherapy in patients with locally advanced thyroid cancer invading the upper airway. Of 597 patients undergoing thyroidectomy for thyroid cancer, 40 were found to have laryngotracheal invasion. Thirty-five patients with superficial invasion underwent cartilage shave procedures with adjuvant radiotherapy; five with full-thickness invasion underwent radical resection, including tracheal sleeve resection (n = 3) or total laryngectomy (n = 2). Histologic subtypes included papillary (n = 32), follicular (n = 2), Hurthle cell (n = 1), medullary (n = 3), and anaplastic (n = 2). Of the cartilage shave group, 25 are currently alive with no evidence of disease at a mean follow-up of 81 months (range 1-290). Six developed isolated local/regional recurrence and were managed with total laryngectomy (n = 1), tracheal resection (n = 1), cervical lymphadenectomy (n = 1), or repeat radiotherapy (n = 3). All six patients remain free of disease at a mean follow-up of 5 years. Of those who underwent initial laryngotracheal resection, four remain free of disease at a mean follow-up of 5 years. The rates of 10-year disease-free survival and overall survival for all patients were 47.9% (95% confidence interval [CI] 24.8, 71.0) and 83.9% (95% CI 70.3, 97.5), respectively. These data suggest that adequate management of thyroid cancer with laryngotracheal invasion can be achieved with a more conservative surgical approach and adjuvant radiotherapy, reserving more radical resections for extensive primary lesions or locally recurrent disease.

Surgical Management of Thyroid Carcinoma with Laryngotracheal Invasion

Thyroid carcinoma that invades the airway can, in most cases, be treated by partial laryngectomy or partial tracheal resection. Total laryngectomy or circumferential tracheal reconstruction may be required in patients with extensive disease. Closure of subglottic and tracheal defects can be accomplished with the sternocleidomastoid myoperiosteal flap in a simple, single-staged procedure. Patterns of invasion and appropriate reconstruction are described.

Laryngotracheal invasion by well‐differentiated thyroid cancer: Diagnosis and management

Ten cases of laryngotracheal invasion by well-differentiated thyroid cancer are described. All the patients were over 40 years of age, with a male preponderance of 4:1. A mass in the neck, stridor, and hemoptysis was the common symptom. Bronchoscopy done in six of ten patients revealed an intraluminal tumour in all. Radiographs of the neck showed invasion of the trachea in six patients. Surgery consisted of tracheostomy alone (three of ten), total thyroidectomy with laryngectomy (one of ten), circumferential resection of trachea (one of ten), and total thyroidectomy with tracheotomy and "shaving" of the intraluminal disease in five of ten patients. Adjuvant external radiation, radioiodine, or laser therapy was given when indicated. Of the ten patients, three died and seven survived. Five of seven were alive without disease for 2.5 years or more, and one had skull metastasis 2 years later but no local disease.

Laryngeal involvement by thyroid disease.

Thyroid tissue or neoplastic derivatives therefrom in the larynx or trachea have their genesis in either ectopia or a direct invasion by carcinoma of the thyroid gland proper. The benign lesions are found preponderantly in patients from regions in which goiter is endemic, and they may represent as much as 7% of all benign tracheal tumors. Laryngotracheal invasion by thyroid carcinoma also has a frequency of approximately 7%, with all histologic types represented.