Surgical Treatment of Locally Advanced Papillary Thyroid Cancer

  • Fatih Tunca


Although the majority of the differentiated thyroid carcinomas belong to low-risk group, 10–15% of these tumors present with locally advanced disease. Aerodigestive tract invasion is one of the challenging problems in these patients. Here we have reported a patient who presented with stage IV tracheal invasion of thyroid cancer and underwent bilateral total thyroidectomy, central neck dissection, bilateral modified radical neck dissection, and tracheal resection and primary anastomosis. The histopathologic examination revealed multicentric papillary thyroid carcinoma of diffuse sclerosing variant. The tumor was 6.5 cm with diffuse lymphovascular invasion and extrathyroidal extension. Ten of the dissected 25 lymph nodes were metastatic. Diffuse angiolymphatic and cartilage invasion was found on partial tracheal resection specimen with negative surgical margins. The patient received postoperative adjuvant radioiodine treatment. On the postoperative 6th month, nodal recurrence was detected at lateral neck region level II, and segmental level II lymphadenectomy was performed.


Thyroid cancer Locally advanced Hemoptysis Tracheal invasion Tracheal resection 


  1. 1.
    Cody HS 3rd., Shah JP. Locally invasive, well-differentiated thyroid cancer: 22 years; experience at Memorial Sloan-Kettering Cancer Center. Am J Surg. 1981;42:480–3.CrossRefGoogle Scholar
  2. 2.
    Andersen PE, Kinsella J, Loree TR, Shaha AR, Shah JP. Differentiated carcinoma of the thyroid with extrathyroidal extension. Am J Surg. 1995;170:467–70.CrossRefGoogle Scholar
  3. 3.
    McCaffrey TV, Bergstralh EJ, Hay ID. Locally invasive papillary thyroid carcinoma: 1940–1990. Head Neck. 1994;16:165–72. Scholar
  4. 4.
    McCaffrey TV, Lipton RJ. Thyroid carcinoma invading the upper aerodigestive system. Laryngoscope. 1990;100:824–30. Scholar
  5. 5.
    Randolph GW, Kamani D. The importance of preoperative laryngoscopy in patients undergoing thyroidectomy: voice, vocal cord function, and the preoperative detection of invasive thyroid malignancy. Surgery. 2006;139:357–62. Scholar
  6. 6.
    Czaja JM, McCaffrey TV. The surgical management of laryngotracheal invasion by well-differentiated papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 1997;123:484–90. Scholar
  7. 7.
    Patel KN, Shaha AR. Locally advanced thyroid cancer. Curr Opin Otolaryngol Head Neck Surg. 2005;13:112–6. Review. Scholar
  8. 8.
    Chiang FY, Wang LF, Huang YF, Lee KW, Kuo WR. Recurrent laryngeal nerve palsy after thyroidectomy with routine identification of the recurrent laryngeal nerve. Surgery. 2005;137:342–7. Scholar
  9. 9.
    Falk SA, McCaffrey TV. Management of the recurrent laryngeal nerve in suspected and proven thyroid cancer. Otolaryngol Head Neck Surg. 1995;113:42–8. Scholar
  10. 10.
    Chan WF, Lang BH, Lo CY. The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: a comparative study on 1000 nerves at risk. Surgery. 2006;140:866–72. Scholar
  11. 11.
    Dralle H, Sekulla C, Haerting J, Timmermann W, Neumann HJ, Kruse E, et al. Risk factors of paralysis and functional outcome after recurrent laryngeal nerve monitoring in thyroid surgery. Surgery. 2004;136:1310–22. Scholar
  12. 12.
    Price DL, Wong RJ, Randolph GW. Invasive thyroid cancer: management of the trachea and esophagus. Otolaryngol Clin N Am. 2008;41:1155–68. Scholar
  13. 13.
    Friedman M, Danielzadeh JA, Caldarelli DD. Treatment of patients with carcinoma of the thyroid invading the airway. Arch Otolaryngol Head Neck Surg. 1994;120:1377–81. Scholar
  14. 14.
    Ballantyne AJ. Resections of the upper aerodigestive tract for locally invasive thyroid cancer. Am J Surg. 1994;168:636–9. Scholar
  15. 15.
    Donnelly MJ, Timon CI, McShane DP. The role of total laryngectomy in the management of intraluminal upper airway invasion by well-differentiated thyroid carcinoma. Ear Nose Throat J. 1994;73:659–62.PubMedGoogle Scholar
  16. 16.
    Shin DH, Mark EJ, Suen HC, Grillo HC. Pathologic staging of papillary carcinoma of the thyroid with airway invasion based on the anatomic manner of extension to the trachea: a clinicopathologic study based on 22 patients who underwent thyroidectomy and airway resection. Hum Pathol. 1993;24:866–70.CrossRefGoogle Scholar
  17. 17.
    McCaffrey JC. Aerodigestive tract invasion by well differentiated thyroid carcinoma: diagnosis, management, prognosis, and biology. Laryngoscope. 2006;116:1–11. Scholar
  18. 18.
    An SY, Kim KH. Surgical management of locally advanced thyroid cancer. Curr Opin Otolaryngol Head Neck Surg. 2010;18:119–23. Scholar
  19. 19.
    Segal K, Shpitzer T, Hazan A, Bachar G, Marshak G, Popovtzer A. Invasive well-differentiated thyroid carcinoma: effect of treatment modalities on outcome. Otolaryngol Head Neck Surg. 2006;134:819–22. Scholar
  20. 20.
    Nishida T, Nakao K, Hamaji M. Differentiated thyroid carcinoma with airway invasion: indication for tracheal resection based on the extent of cancer invasion. J Thorac Cardiovasc Surg. 1997;114:84–92. Scholar
  21. 21.
    Kasperbauer JL. Locally advanced thyroid carcinoma. Ann Otol Rhinol Laryngol. 2004;113:749–53. Scholar

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© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Fatih Tunca
    • 1
  1. 1.Division of Endocrine SurgeryIstanbul University, Istanbul Medical FacultyIstanbulTurkey

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