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Surgical Treatment of Locally Advanced Papillary Thyroid Cancer

  • Fatih Tunca
Chapter

Abstract

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.

Keywords

Thyroid cancer Locally advanced Hemoptysis Tracheal invasion Tracheal resection 

References

  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.  https://doi.org/10.1002/hed.288016021.CrossRefPubMedGoogle Scholar
  4. 4.
    McCaffrey TV, Lipton RJ. Thyroid carcinoma invading the upper aerodigestive system. Laryngoscope. 1990;100:824–30.  https://doi.org/10.1288/00005537-199008000-00006.CrossRefPubMedGoogle 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.  https://doi.org/10.1016/j.surg.2005.08.009.CrossRefPubMedGoogle 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.  https://doi.org/10.1001/archotol.1997.01900050030003.CrossRefPubMedGoogle Scholar
  7. 7.
    Patel KN, Shaha AR. Locally advanced thyroid cancer. Curr Opin Otolaryngol Head Neck Surg. 2005;13:112–6. Review.  https://doi.org/10.1097/01.moo.0000156161.82671.43.CrossRefPubMedGoogle 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.  https://doi.org/10.1016/j.surg.2004.09.008.CrossRefPubMedGoogle 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.  https://doi.org/10.1016/S0194-59989570143-5.CrossRefPubMedGoogle 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.  https://doi.org/10.1016/j.surg.2006.07.017.CrossRefPubMedGoogle 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.  https://doi.org/10.1016/j.surg.2004.07.018.CrossRefPubMedGoogle 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.  https://doi.org/10.1016/j.otc.2008.08.002.CrossRefGoogle 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.  https://doi.org/10.1001/archotol.1994.01880360071013.CrossRefPubMedGoogle Scholar
  14. 14.
    Ballantyne AJ. Resections of the upper aerodigestive tract for locally invasive thyroid cancer. Am J Surg. 1994;168:636–9.  https://doi.org/10.1016/S0002-9610(05)80136-9.CrossRefPubMedGoogle 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.  https://doi.org/10.1097/01.MLG.0000200428.26975.86.CrossRefPubMedGoogle Scholar
  18. 18.
    An SY, Kim KH. Surgical management of locally advanced thyroid cancer. Curr Opin Otolaryngol Head Neck Surg. 2010;18:119–23.  https://doi.org/10.1097/MOO.0b013e3283374d84.CrossRefPubMedGoogle 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.  https://doi.org/10.1016/j.otohns.2005.11.040.CrossRefPubMedGoogle 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.  https://doi.org/10.1016/S0022-5223(97)70120-X.CrossRefPubMedGoogle Scholar
  21. 21.
    Kasperbauer JL. Locally advanced thyroid carcinoma. Ann Otol Rhinol Laryngol. 2004;113:749–53.  https://doi.org/10.1177/000348940411300914.CrossRefPubMedGoogle Scholar

Copyright information

© 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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