Tracheal and laryngeal resections for differentiated thyroid cancer

Extensive local invasion of the trachea or larynx by differentiated thyroid cancer has usually resulted in a conservative therapeutic approach, including at least a thyroid biopsy and external beam irradiation. Thyroidectomy, if performed, has also allowed radioactive iodine administration with variable uptake. Survival rates are rarely reported, but generally considered dismal. In light of this, an aggressive surgical approach was initiated with attempted resection of all local tumor tissue. Seven patients (five females and two males), 38 to 82 years of age (mean, 64), underwent tracheal sleeve resection for obstructing lesions (four patients) or partial laryngectomy (three patients) for locally invasive tumors. Esophageal resections were included in two patients. Follicular cancer was seen in two patients; Hürthle cell cancer was seen in three patients; and papillary cancer was seen in two patients. Patients were also treated with radioactive iodine and external beam irradiation. Patients were followed regularly postoperatively to establish survival. No operative deaths were seen. Two patients died of disease at 57 and 47 months postoperatively. One died of natural causes 24 months after surgery. Four patients are alive at 10, 29, 114, and 118 months after resection. Mean survival, to date, is 51.3 months. Aggressive attempts at surgical resection of differentiated thyroid cancers seems warranted for tumors obstructing the trachea or involving the larynx. It has been well tolerated and is associated with a >4-year average survival. A nihilistic approach no longer can be justified in these patients.