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The management of thyroid carcinoma invading the larynx or trachea

Authors

  • Jimmie Honings MD,

    1. Division of Thoracic Surgery , Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A.
    2. Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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  • Antonia E. Stephen MD, PhD,

    1. Division of Surgical Oncology , Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A.
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  • Henri A. Marres MD, PhD,

    1. Department of Oto-Rhino-Laryngology and Head and Neck Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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  • Henning A. Gaissert MD, PhD

    Corresponding author
    1. Division of Thoracic Surgery , Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, U.S.A.
    • Massachusetts General Hospital, Blake 1570, 32 Fruit Street, Boston, MA 02114
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  • Henning A. Gaissert, MD, PhD had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Abstract

Objectives/Hypothesis:

To describe the controversies in the management of thyroid carcinoma invading the airway.

Study Design:

Contemporary review of literature; level of evidence: 5.

Results:

Invasion of the larynx or trachea by thyroid carcinoma is uncommon and often identified at the time of operation, when the surgeon must decide the extent of resection. Invasion of the airway is associated with loss of tumor differentiation and a reduction in long-term survival compared to tumors limited to the thyroid gland. Whether or not the invaded airway should be resected remains controversial. Tangential shave excision of tumor is commonly performed, despite a marked risk of local recurrence. Circumferential sleeve resection of the larynx and trachea is safe and lowers the risk of local recurrence. In recurrent disease, laryngotracheal resection provides effective palliation of airway obstruction and hemoptysis.

Conclusions:

Long-term (>10–20 years) prospective studies are required to compare the outcome after shave excision with segmental airway resection for thyroid carcinoma. Based on the current literature and on our experience, we advocate circumferential tracheal resection in the setting of airway involvement. Laryngoscope, 2010

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