When would we advocate a total thyroidectomy in cases of hypopharyngeal carcinoma?

The incidence of invasion of the thyroid gland by hypopharyngeal carcinomas is reported to be up to 57%. Our aim was to analyze the frequency of thyroid gland invasion in hypopharyngeal carcinoma treated by thyroidectomy with total laryngopharyngectomy and to identify patients in whom preservation of the thyroid gland is oncologically feasible and hence reduces post-operative hypothyroidism.

This retrospective cohort study included 58 patients with hypopharyngeal squamous cell carcinoma treated by thyroidectomy with total laryngopharyngectomy at the National Cancer Institute, Cairo University between May 1996 and October 2005. Thyroid gland involvement was analyzed through review of charts and pathologic reports. Patients were assessed preoperatively by CT. The correlation between the thyroid gland involvement and the clinical and radiologic CT findings was meticulously examined.

Thyroid gland involvement occurred in 37.9% (22/58) of all patients. T4 hypopharyngeal tumors were present in 29.3% (n=17/58) of patients, paratracheal LN invasion was present in 37.9% (22/58) of patients, thyroid cartilage invasion was obvious in 19% (11/58) of patients, and previous radiotherapy was present in 5.2% (3/58) of patients. All patients with T4 hypopharyngeal tumors (n=17/58) and with thyroid cartilage involvement (n=11/58) had thyroid gland invasion as well. T4 hypopharyngeal tumors, paratracheal LN invasion, and thyroid cartilage invasion were statistically significant factors (P<0.001, P=0.009 and P<0.001 respectively) in independent correlation.

We would advocate a total thyroidectomy in cases of advanced stages of hypopharyngeal carcinoma, bilateral tumors, postcricoid carcinoma and in all patients with definite radiological evidence of thyroid gland invasion.