Resectional management of airway invasion by thyroid carcinoma

Invasion of the trachea by thyroid carcinoma is best managed by resection with airway reconstruction. Localized extension of tumor may also require esophageal resection or radical resection including laryngectomy with mediastinal tracheostomy. Twenty-two patients (12 with papillary, 3 with follicular, 4 with mixed papillary and follicular, and 3 with undifferentiated carcinoma) underwent resection--16 with airway reconstruction and 6 with cervicomediastinal en bloc resection with mediastinal tracheostomy. Eleven had prior thyroidectomy. Ten of those having airway restitution required cylindrical tracheal resection, 5 had resection of trachea with a portion of the larynx, and 1 had wedge resection. Three undergoing laryngotracheal resection also needed esophagectomy. Colon reconstruction was used. Fifteen of the 16 having airway reconstruction had good surgical results with speech preservation. One died of complications due to prior irradiation. One of 6 undergoing radical resection died postoperatively. Six of the 20 survivors died of recurrence in 1 2/3 to 9 years, and 2 others died of other diseases. Three who had known pulmonary metastases at the time of palliative operation are alive between 2 and 3 2/3 years postoperatively, and a fourth who has pulmonary metastases is alive 6 1/6 years later. Eight patients are alive without disease from 1/12 to 8 3/4 years. Only two patients had airway recurrence. Resection and primary reconstruction of the trachea invaded by carcinoma of the thyroid should be done in the absence of extensive metastases when technically feasible. It offers prolonged palliation, avoidance of suffocation due to bleeding or obstruction, and an opportunity for cure. In carefully selected patients with massive regional involvement, radical excision with laryngectomy and esophagectomy is also appropriate.