Total thyroidectomy or hemithyroidectomy together with a total laryngectomy (TL) or pharyngo laryngectomy (TPL) for (pharyngo) laryngeal cancer often renders the patient hypothyroid and commits them to life-long thyroid hormone replacement. To determine the incidence of thyroid gland invasion (TG) in patients undergoing TL or TPL with total thyroidectomy (TThy) or lobectomy (HThy) for advanced laryngeal or hypo pharyngeal cancer and to assess predicative factors. Retrospective analysis of 35 patients from 2007 to 2010. Specimens were examined to determine the incidence of TG invasion and relevant predicative factors such as histological grade and subglottic extension. Pre-operative imaging was reviewed to assess for radiological evidence of TG invasion. TL and TThy was performed in 13 patients. TL and HThy was performed in four patients and TPL and TThy was performed in 18 patients. Surgery was performed for primary and recurrent cancer in 29 and six patients, respectively. Histological evidence of invasion of the TG was found in three patients. Relationship was found between TG invasion and subsite of primary carcinoma and the presence of subglottic extension. No relationship was found between TG invasion and patient's sex, stage of primary disease at surgery, degree of differentiation. In addition, no significant relationship was found between the presence of TG invasion and recurrent disease. Invasion of the TG in patients undergoing a TL or TPL is a rare event and limits the need for a TTHy in most cases.

Introduction: for organ and function preservation, chemoradiotherapy is gaining popularity for primary treatment of advanced head and neck cancer, reserveing surgery for salvage. Methods: Retrospective outcome analysis to determine the results of salvage surgery after failure of primary treatment of advanced head and neck cancer by chemoradiotherapy. 104 patients with advanced head and cancer were initially treated by chemoradiotherapy. Follow-up was evaluated in 27 patients undergoing salvage surgery for recurrent tumor (larynx n = 13; oral cavity n = 9; hypopharynx n = 5). The initial tumor is stage T3 in 11 cases and T4 in 16 cases. 10 patients had primary tumors stage III and 17 patients had tumors stage IV. Results: One postoperative death occured following surgery. The overall incidence of complications was 9/ 27 (%). Recurrent disease developed at the primary initially treated in 25 cases and in the neck in 2 cases after a mean follow-up of 11 months (3 -136 months). After salvage surgery, loco-regional recurrence and/ or distant disease developed in 10/27 patients after a mean follow-up of 4 months. 6/10 (60%) patients died after re-recurrence despite salvage chemotherapy. Conclusion: Salvage surgery after failure of initial chemoradiotherapy is burdened with high morbidity and bad oncological outcome. We demonstrated that it is difficult to salvage locally recurrent head and neck cancer especially at more advanced T-stages or when tumor recur. The limited effect of surgical salvage for recurrent tumor need to be addressed when choosing the initial treatment plan.

No abstract