Window Resection for Intraluminal Cricotracheal Invasion by Papillary Thyroid Carcinoma

Invasion of the upper aerodigestive tract by papillary thyroid carcinoma (PTC) affects both prognosis and quality of life. We assessed the efficacy of window resection for patients with intraluminal cricotracheal invasion.

Clinical data were retrospectively reviewed for all patients with PTC undergoing surgery at our institution during 1981-2009. Seventy-six patients with intraluminal cricotracheal invasion were enrolled, including 34 relapsing patients.

The 10-year disease-specific survival rate of 42 patients with intraluminal invasion who underwent initial surgery was 60.8%. The lesion was located on the laryngo-trachea in 3 (4%) of 12 patients with locoregional recurrence. No major surgical complications were associated with cricotracheal resection. Stomal closure was achieved in 30 of 76 patients (39%). Twelve patients (16%) had a permanent stoma that was directly related to cricotracheal invasion. Their stomas had been caused by large cricotracheal defects with greater than or equal to 50% circumferential resection of the trachea. Sixty-seven patients (88%) had PTC invasion into other aerodigestive structures, including the recurrent laryngeal nerve (n = 54), esophagus (n = 38), and thyroid cartilage or intraluminal invasion of the larynx (laryngeal invasion n = 23). Multivariate analysis showed that cricotracheal invasion accompanied by recurrent laryngeal nerve invasion was predictive of permanent stoma (odds ratio 0.32; 95% CI 0.107-0.945; p = 0.039).

Window resection appears to be an effective treatment option for patients with intraluminal cricotracheal invasion. However, this surgical technique may be inappropriate for the treatment of large cricotracheal defects without a supportive hard structure.