Is thyroid excision mandatory with laryngectomy in carcinoma larynx?

Baghel, Surendra Singh; Singhal, Pawan; Verma, Neha; Sehra, Ritu; Yadav, Rajkumar; Agarwal, Sunita; Sharma, Malvika; Gupta, Dileep

doi:10.1186/s12885-020-07205-5

Cited by 8 publications

(4 citation statements)

References 30 publications

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“…28 Baghel et al recommended thyroidectomy only in gross radiological or intraoperative thyroid gland involvement and subglottic extension. 25 In another study, 88% of the patients who had lobectomies during laryngectomy needed thyroid supplementation later in life. 29…”

Section: Discussionmentioning

confidence: 98%

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Frequency of Thyroid Gland Invasion by Laryngeal Squamous Cell Carcinoma: The Role of Subglottic Extension

Pasha

Wasif

Ikram

et al. 2022

Int Arch Otorhinolaryngol

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Introduction Management of the thyroid gland during laryngectomy has been controversial. The primary tumor may invade the thyroid gland by direct invasion or lymphovascular spread. Hypothyroidism and hypoparathyroidism are potential risks when lobectomy or total thyroidectomy are performed simultaneously. Objective To report the frequency of thyroid gland involvement by primary laryngeal squamous cell carcinoma in patients undergoing laryngectomy and to identify possible risk factors for thyroid gland involvement so that judicious excision of thyroid gland can be attained. Methods We performed a retrospective review of 9 years. Data was collected from medical records of patients dated from December 2009 to October 2018. All patients with laryngeal cancer who underwent laryngectomy with lobectomy or total thyroidectomy were included in the present study. Results We reviewed 151 laryngectomy records. A total of 130 surgeries included the thyroid gland with the excised specimen and were available for analysis. There were 124 males and 6 females. The mean age was 59.4 years old. The glottis was the most common subsite involved, in 70 patients, followed by 38 transglottic, 16 supraglottic and 03 subglottic tumors. On histology, 12 out of 130 excised thyroid glands were involved by squamous cell carcinoma. Only subglottic involvement (p = 0.01) was significantly associated with thyroid gland invasion (TGI). Type of laryngectomy, subsite of the primary tumor, thyroid cartilage involvement, neck nodal metastases, and perineural and lymphatic invasion by the primary tumor were not associated with TGI. Conclusion Only subglottic involvement is associated with TGI; therefore, preoperative and intraoperative assessment is necessary prior to considering excision of the thyroid gland.

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Section: Discussionmentioning

confidence: 98%

“…Isolated total laryngectomy causes hypothyroidism in 20 to 63% of the patients. 25 The morbidity is worse in patients undergoing adjuvant radiation to the neck. 14 Preoperative radiation with salvage laryngectomy results in a greater risk of hypothyroidism than laryngectomy, followed by postoperative radiation.…”

Section: Discussionmentioning

confidence: 99%

Frequency of Thyroid Gland Invasion by Laryngeal Squamous Cell Carcinoma: The Role of Subglottic Extension

Pasha

Wasif

Ikram

et al. 2022

Int Arch Otorhinolaryngol

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“…For decades Total laryngectomy with ipsilateral hemi thyroidectomy has been the treatment of choice by head and neck surgeons worldwide. Both total thyroidectomy and hemi thyroidectomy may render the patient at risk of permanent or temporary hypothyroidism and/or hypoparathyroidism 19 leaving patients on the mercy of permanent replacement with Thyroxin and Calcium supplements respectively adding to their morbidity and increasing cost, no of hospital visits and financial burden both over the patient and the hospital. However no risk of hypothyroidism or hypoparathyroidism is associated with Thyroid sparing Total Laryngectomy 15 .…”

Section: Discussionmentioning

confidence: 99%

Outcome of Novel Treatment of Thyroid Gland in Patients with Advance Carcinoma Larynx

Haider¹,

Aziz²,

Wahab³

et al. 2022

PJMHS

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Background: Among the carcinomas Head and Neck surgeon encounter, carcinoma larynx is amongst the most commons. Thyroid gland is close to larynx so is its risk to be involved by laryngeal malignancies. Removing whole or part of thyroid gland may put the patient at risk of permanent or temporary hypothyroidism and hypoparathyroidism. In recent past a number of risk factors are nominated to predict invasion of thyroid gland by laryngeal malignancies. So, there is a need to re-consider the management of thyroid gland in total laryngectomy. Aim: To justify the management of thyroid gland in advance carcinoma larynx. Study design: The study is cross sectional Randomized Control Trial. Place and duration of study: We conducted this study in ENT Unit I of Jinnah Hospital Lahore from June 2021 to May 2022. Methodology: A total of 20 patients were included in this study and were randomly divided into two groups on the basis of management of thyroid gland. Group A underwent hemi thyroidectomy while thyroid sparing total laryngectomy was done in group B. Histological evaluation of thyroid Gland was done in group A in addition to analysis of local recurrence in both Groups. Mean duration of follow-up was 6 months. Data analysis was done by using SPSS software and is presented in tabulated forms as percentages. Results: The study showed that thyroid gland was not involved in all cases of advance laryngeal malignancies thus obviating the need of total or hemithyroidectomy in all patients with advance Squamous Cell Carcinoma Larynx. Practical implication: All the cases of advance laryngeal malignancies used to undergo total or at least hemithyroidectomy as bystander of total laryngectomy. This study helps the surgeon decide whether a patient with proven laryngeal malignancy needs thyroid gland manipulation or not, thus decreasing the morbidity of the patient and improving cost effectiveness. Conclusion: This study made us reach to the conclusion that in patients with Grade I and II SCC, with no clinical or radiological involvement of thyroid and cricoid cartilage, thyroid gland, strap muscles or skin, there is no need for manipulation of thyroid gland in patients undergoing total Laryngectomy. Keywords: Laryngeal Carcinoma, Thyroid Gland management, Total Laryngectomy with Hemi thyroidectomy,

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“…Baghel et al studied the need for thyroid excision along with laryngectomy in carcinoma larynx, and concluded that the invasion of thyroid gland by laryngeal cancer is uncommon, and hence advocated total thyroidectomy to be done along with total laryngectomy in cases which had gross clinical, radiological or intraoperative thyroid gland involvement, subglottic extension and thyroid cartilage invasion. 19 Ceylan et al 20 in their study also concluded that there may not be a need to perform thyroidectomy in all total laryngectomy cases and recommended thyroidectomy to be done in laryngeal carcinoma cases with subglottic extension and advanced hypopharyngeal tumours. There is, however, no doubt that lesions involving the glottic larynx with significant subglottic extension mandate an ipsilateral thyroid lobectomy be done, to facilitate ipsilateral tracheo-oesophageal lymph node clearance.…”

Section: Study Year Number Of Casesmentioning

confidence: 97%

Staging of Laryngeal Cancer: Clinicoradiological versus Histopathological Findings using Modified Laryngeal Sectioning

Sinha,

Sen,

Saha

2023

BJOHNS

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INTRODUCTION: Laryngeal cancer is commonly encountered in India. Post operative whole organ sectioning of the larynx, although informative, can often be tedious and cumbersome. This study aims to define a modified method of laryngeal sectioning and to assess its level of agreement with pre-operative clinicoradiological findings with regard to T-stage of laryngeal cancer. METHODOLOGY: Prospective study was conducted on 15 patients diagnosed with laryngeal carcinoma, who underwent total laryngectomy with neck dissection. The pre-operative clinicoradiological T-stage, was compared to the post-operative pathological T-stage, obtained after histopathological examination of sections taken from relevant areas of the total laryngectomy specimen using modified laryngeal sectioning. RESULTS: When compared to the pathological staging obtained after modified laryngeal sectioning, clinical T-staging over-staged the tumour in 3 cases and under-staged the tumour in 2 cases, and was similar in the remaining 10 cases. The level of agreement in determining the T-stage was ‘fair’. CONCLUSION: The T-stages determined by pre-operative clinicoradiological findings and post-operative histopathological findings after modified laryngeal sectioning, were similar in two-third cases. While whole organ laryngeal sectioning remains the gold standard, it is often a costly and cumbersome process. We propose the use of representative tissue samples from the areas of interest for histopathological examination, obtained by sectioning the larynx at relevant points only, as it saves time and is less resource intensive.

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Is thyroid excision mandatory with laryngectomy in carcinoma larynx?

Cited by 8 publications

References 30 publications

Frequency of Thyroid Gland Invasion by Laryngeal Squamous Cell Carcinoma: The Role of Subglottic Extension

Frequency of Thyroid Gland Invasion by Laryngeal Squamous Cell Carcinoma: The Role of Subglottic Extension

Outcome of Novel Treatment of Thyroid Gland in Patients with Advance Carcinoma Larynx

Staging of Laryngeal Cancer: Clinicoradiological versus Histopathological Findings using Modified Laryngeal Sectioning

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