Surgical management of thyroid cancer invading the trachea

Airway invasion by thyroid carcinoma is a life-threatening disease and its severity is emphasized by the high incidence of death by suffocation because of bleeding or airway obstruction. A favorable prognosis may be obtained, however, with proper treatment of tracheal invasion. The standardization of reliable techniques for tracheal resection and reconstruction has made radical surgery a reasonable therapeutic approach to thyroid carcinomas invading the trachea. When the cricoid is invaded by the tumor, partial laryngeal resection becomes necessary but subsequent airway reconstruction is still possible with preservation of laryngeal function. Laryngectomy with placement of an end tracheostomy should be performed only in patients with extensive laryngeal infiltration. Our personal experience at the University of Milan Medical School supports the indications, techniques, and results reported in the literature and shows the effectiveness of tracheal resection and reconstruction in the treatment of infiltrating thyroid carcinoma. Tracheal resection and reconstruction for invasive thyroid carcinoma prevents death by asphyxiation, provides long-lasting palliation with good quality of life, and may even be curative.