Resections of the upper aerodigestive tract for locally invasive thyroid cancer

In view of the indolent nature of most cancers of the thyroid, particularly of the papillary and follicular variety, the decision to remove a segment of the upper aerodigestive tract when the cancer is either close to or invading this area is a difficult one. It was felt relevant to review the experience at the M.D. Anderson Hospital to see when such resections were necessary, how they were repaired, and the survival rates.

Of the 1,098 patients with cancers of the thyroid treated surgically at M.D. Anderson Cancer Center from 1954 to 1993, 46 underwent resections of some portion of the upper aerodigestive tract for invasive cancer. These included 35 patients who had histories of prior surgical treatment with or without radiation or radioactive iodine therapy. The operations included 27 total and 5 partial laryngectomies, 1 circumferential and 13 partial resections of the trachea, and 5 circumferential and 10 partial esophagectomies. Several patients had combinations of these procedures. Details of the repairs are provided. Postoperative radiation or radioactive iodine treatment was administered when indicated.

Local recurrence was infrequent. Most deaths occurred from either pulmonary metastasis or causes other than the cancer. The 5-year survival rate for all patients exceeded 50%. More than 70% of patients with papillary and follicular cancers survived for 5 years, and some for up to 30 years.

Although it cannot be stated with any degree of certainty if a resection of a portion of the upper aerodigestive tract should be done at the time of the initial surgical procedure, it is apparent that there are some situations in which the resection should be done because of severe local problems A variety of methods of repair are available, and the survival rate is greater than 50% for all such procedures, with those having the papillary and follicular variety surviving for 5 years in more than 70% of cases. Patients can exist with severe local problems for a number of years and it is sometimes the patient who decides when the resection should be done.