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J Thorac Cardiovasc Surg 1997;114:84-92
© 1997 Mosby, Inc.

GENERAL THORACIC SURGERY

DIFFERENTIATED THYROID CARCINOMA WITH AIRWAY INVASION: INDICATION FOR TRACHEAL RESECTION BASED ON THE EXTENT OF CANCER INVASION

Received for publication Sept. 23, 1996 revisions requested Nov. 11, 1996; revisions received Feb. 20, 1997; accepted for publication Feb. 25, 1997. Address for reprints: Toshirou Nishida, MD, PhD, First Department of Surgery, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka 565, Japan.

Abstract

Objective: Although aggressive approaches to locally invasive differentiated thyroid carcinoma are reported to improve the prognosis, few investigations have provided an indication for airway resection. The present study was undertaken to determine the best indication for airway resection for differentiated thyroid carcinoma invading the trachea. Methods: One hundred seventeen patients with differentiated thyroid carcinoma invading surrounding structures were retrospectively studied for local failures and prognosis and were divided into five groups mainly on the basis of macroscopic findings: Group 1 consisted of 40 patients who underwent tracheal resection for deep tracheal invasion; group 2 consisted of 14 patients with deep tracheal invasion and no airway resection; group 3 consisted of 13 patients with superficial tracheal invasion and no airway resection; group 4 comprised 48 patients with extrathyroidal invasion other than laryngotracheal structures; and group 5 consisted of two patients who underwent tracheal resection for superficial invasion. Results: Resectional management of the airway for patients with deep tracheal invasion decreased local recurrence and improved postoperative prognosis compared with nonresectional management for deep invasion (group 1 vs 2). Nonresectional management of the tumor, or shaving off tumor from the trachea for patients with superficial invasion, did not increase postoperative local failures or mortality (group 3 vs groups 4, 5, and 1). Conclusion: These results implied that differentiated thyroid carcinomas with superficially limited invasion could be treated successfully by nonresectional management of the trachea and that those with deep invasion should be treated by resection of the invaded trachea

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