Invasive differentiated thyroid carcinoma: Tracheal resection and reconstruction procedures in the hands of the endocrine surgeon

AbstractThe majority of well differentiated thyroid carcinoma are tumours of low grade malignancy. Laryngotracheal invasion by well differentiated thyroid carcinoma is an uncommon occurrence. The surgical management of patients with thyroid cancer invading the upper airway has primarily been by total laryngectomy. Other surgeons recommend in selected cases partial laryngeal and/or tracheal resection.A total of 122 patients with thyroid carcinoma were treated in our department between 1967 and 1982. Only seven patients with well differentiated tumours had airway invasion. In these seven patients we used a partial laryngeal and/or tracheal resection. In three of the patients with tracheal invasion a myoperichondrial flap was used for closing the tracheal defect. A partial resection of the larynx and trachea, and end to end anastomosis between the trachea and the remaining part of the larynx was performed in another four patients.

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Differentiated thyroid carcinoma with airway invasion: Indication for tracheal resection based on the extent of cancer invasion

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/s0022-5223(97)70120-x ◽

1997 ◽

Vol 114 (1) ◽

pp. 84-92 ◽

Cited By ~ 84

Author(s):

Toshirou Nishida ◽

Kazuyasu Nakao ◽

Masayasu Hamaji

Keyword(s):

Thyroid Carcinoma ◽

Differentiated Thyroid Carcinoma ◽

Cancer Invasion ◽

Tracheal Resection ◽

Airway Invasion

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A Successful Tracheal Resection and Anastomosis in Papillary Thyroid Carcinoma with Tracheal Invasion

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.438 ◽

2018 ◽

Vol 6 (11) ◽

pp. 2161-2164 ◽

Cited By ~ 1

Author(s):

I Gede Budhi Setiawan ◽

Putu Anda Tusta Adiputra

Keyword(s):

Case Report ◽

Thyroid Carcinoma ◽

Positive Impact ◽

Differentiated Thyroid Carcinoma ◽

Tracheal Resection ◽

Difficult Case ◽

Sleeve Resection ◽

Tracheal Invasion ◽

Satisfactory Outcome ◽

End To End

BACKGROUND: Well-differentiated thyroid carcinoma (DTC) can be locally aggressive, invading aerodigestive tract. The rationale for aggressive surgical resection in this clinical setting is supported by a long-term local control with a positive impact on survival. CASE REPORT: A 60-year-old male patient was consulted by a digestive surgeon of unaware thyroid enlargement. Physical and imaging examination showed a suspect of thyroid malignancy. During surgery, we found that a tumour had invaded the anterior side of the trachea. Resection of three tracheal rings was performed, with end-to-end anastomosis. Surgical outcome regarding nervous preservation and parathyroid glands was good as well as cosmetic aspect. During one-year follow-up, no indication of tumour recurrence was found. The management of locally invasive DTC has been controversial yielding the palliative surgery modalities. Advances in surgical technique have given a new perspective of resection in a difficult case. This case report was managed by sleeve resection with end-to-end anastomosis which showed a satisfactory outcome functionally and cosmetically. CONCLUSION: Sleeve resection with primary reconstruction of the trachea is a simple one-stage procedure which can adequately address the problem of tracheal invasion by thyroid cancer.

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Segmental tracheal resection for invasive differentiated thyroid carcinoma. Our experience in eight cases

Langenbeck s Archives of Surgery ◽

10.1007/s00423-013-1127-9 ◽

2013 ◽

Vol 398 (8) ◽

pp. 1075-1082 ◽

Cited By ~ 7

Author(s):

Claudio Mossetti ◽

Nicola Palestini ◽

Maria Cristina Bruna ◽

Michele Camandona ◽

Milena Freddi ◽

...

Keyword(s):

Thyroid Carcinoma ◽

Differentiated Thyroid Carcinoma ◽

Tracheal Resection

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A Single Recombinant Human Thyrotropin-Stimulated Serum Thyroglobulin Measurement Predicts Differentiated Thyroid Carcinoma Metastases Three to Five Years Later

Yearbook of Surgery ◽

10.1016/s0090-3671(08)70416-6 ◽

2006 ◽

Vol 2006 ◽

pp. 152-153

Author(s):

T.J. Fahey

Keyword(s):

Thyroid Carcinoma ◽

Differentiated Thyroid Carcinoma ◽

Serum Thyroglobulin ◽

Recombinant Human Thyrotropin

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Clinical evaluation of a new thyroglobulin immunoradiometric assay in the follow-up of differentiated thyroid carcinoma

Nuklearmedizin ◽

10.1055/s-0038-1625299 ◽

2003 ◽

Vol 42 (02) ◽

pp. 71-77 ◽

Cited By ~ 4

Author(s):

I. Schreivogel ◽

C. Angerstein ◽

U. Siefker ◽

K. Lehmann ◽

G. Altenvoerde ◽

...

Keyword(s):

Thyroid Carcinoma ◽

Residual Disease ◽

False Negative ◽

Differentiated Thyroid Carcinoma ◽

Threshold Concentration ◽

High Rate ◽

Functional Assay ◽

Hypothyroid Patient ◽

Assay Sensitivity ◽

Significant Difference

SummaryAim: Formal and clinical comparison of a new 3rd-gene-ration-Tg-IRMA (3-G-IRMA; Dynotest®Tg-plus) with a conventional Tg-IRMA (3-G-IRMA; SELco®Tg-assay) for patients with differentiated thyroid carcinoma. In addition we evaluated, if thyroglobulin (Tg) levels above a specific threshold concentration indicate the need for further investigations for residual disease. Patients, methods: Tg concentration of 105 sera of 93 consecutive patients with a differentiated thyroid cancer was determined with both assays and compared at different cut-off values (Dynotest®Tg-plus: 0.2, 1, 2 ng/ml; SELco®Tg-assay: 0.5, 1, 2 ng/ml) with the clinical results in respect to the corresponding TSH concentration. Results: Tg concentration did not show any significant difference (SELco®Tg-assay 0.5 ng/ml, Dynotest® Tg-plus 0.2 ng/ml). The Tg-values of both assays correlated with 97%. However, correlation of recovery in both assays was small (40%). The sensitivities and specificities of both assays at different cut-offs and TSH values did not reveal significant differences. In patients with TSH concentration >30 µU/ml the functional assay sensitivity was superior to arbitrary cut-offs in the decision to start further evaluations. Conclusions: In our study neither formal nor clinical significant differences between two Tg-assays were found. In a hypothyroid patient (TSH >30 µU/ml, Tg concentration exceeding the functional assay sensitivity) further investigations for residual disease are warranted. Higher thresholds are of limited value, due to a inacceptable high rate of false negative results.

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131J-speichernde pulmonale und ossäre Metastasen differenzierter Schilddrüsenkarzinome bei niedrigem Serum-Thyreoglobulinspiegel – Ausnahme in der Tumornachsorge?

Nuklearmedizin ◽

10.1055/s-0038-1628878 ◽

1987 ◽

Vol 26 (03) ◽

pp. 139-142 ◽

Cited By ~ 4

Author(s):

G. Arning ◽

O. Schober ◽

H. Hundeshagen ◽

Ch. Ehrenheim

Keyword(s):

Serum Level ◽

Thyroid Carcinoma ◽

Bone Metastases ◽

Differentiated Thyroid Carcinoma ◽

Serum Thyroglobulin ◽

Thyroglobulin Level ◽

Low Serum

In the follow-up of differentiated thyroid carcinoma it is discussed whether the tumormarker thyroglobulin can replace the1311 scan, especially when the thyroglobulin serum level is normal. A positive1311 scan of metastases in the follow-up of patients with differentiated thyroid carcinoma combined with a low serum thyroglobulin level is extremely rare. The literature shows a frequency of about 4%. Recently we found 3 cases with a positive1311 scan demonstrating pulmonary and bone metastases whereas the serum thyroglobulin level was low.

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