Extralaryngeal Spread in Total Laryngectomy: Comparing the Need for Thyroidectomy

Area of Science:

• Oncology
• Otolaryngology
• Surgical Pathology

Background:

• Thyroid preservation during total laryngectomy (TL) practices vary among surgeons.
• This variation creates an opportunity to compare outcomes in patients with and without thyroidectomy during TL.

Purpose of the Study:

• To compare disease outcomes in patients undergoing total laryngectomy (TL) with or without thyroidectomy.
• To evaluate the impact of thyroid preservation on recurrence rates, mortality, and tumor staging.

Main Methods:

• Retrospective chart review of 147 patients who underwent TL for laryngeal or hypopharyngeal squamous cell carcinoma (2014-2022).
• Data collected included demographics, surgical procedures (thyroidectomy variations), pathological staging, and adjuvant therapy.
• Comparison between groups: no thyroid removal (NT) versus any thyroidectomy (T), and four surgical groups.

Main Results:

• No significant difference in recurrence rates or recurrence-related mortality between patients with or without thyroidectomy (P = .156).
• Significant difference in T staging and prognostic staging between groups (P = .043).
• Patients without thyroid removal were more likely to be T3, while those with thyroidectomy were more likely to be T4. 27% of thyroidectomy patients had positive thyroid gland involvement.

Conclusions:

• Thyroidectomy during TL does not significantly affect recurrence or mortality.
• Thyroid preservation may be associated with lower T-stage disease.
• A notable percentage of thyroidectomy specimens show gland invasion, underscoring the importance of considering thyroid removal in TL.