The Role of Thyroidectomy in Advanced Laryngeal and Pharyngolaryngeal Carcinoma

Abstract

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.

Evidence‐based management of the thyroid gland during a total laryngectomy

“…Thyroid gland invasion is part of the extension of anterior extralaryngeal cancer . As reported by Chen et al, the most common route of extralaryngeal spread of glottic SCC is through the cricothyroid membrane .…”

“…Thyroid gland invasion is part of the extension of anterior extralaryngeal cancer. 1,2,[9][10][11][12][13][14] As reported by Chen et al, the most common route of extralaryngeal spread of glottic SCC is through the cricothyroid membrane. 15 CT scan sensitivity is low for thyroid cartilage or cricothyroid membrane invasion, which were associated with TGI in our series.…”

Hypocalcaemia in pharyngolaryngectomy: Preservation or autotransplantation of parathyroid glands

“…Ipsilateral hemithyroidectomy in advanced hypopharyngeal and laryngeal cancer is supported by literature demonstrating superior oncological control. 12 , 17 Basheeth et al 6 also demonstrated a significant relationship between tumor stage (pT4) and hypocalcaemia ( P = 0.05), but not with extent of thyroidectomy or pharyngectomy, while others have suggested pharyngectomy as a risk. 5 Comparatively, rates in the total and partial pharyngectomy subgroups reveal a higher permanent and transient hypocalcaemia rate for those undergoing total pharyngectomy.…”

Incidence and predictors of thyroid gland invasion by laryngeal carcinoma: a 7-year experience review

“…The thyroid gland is located in the lymphatic drainage pathway of the larynx which adds to the risk of lymphatic invasion of the gland by malignant laryngeal tumors. For these reasons, it has been routinely practiced performing HT or TT together with TL for the management of LC [1][2][3][4][5].…”

“…Primary and salvage total laryngectomy (TL) are commonly performed for the management of laryngeal carcinoma (LC) [1]. The management of a clinically negative thyroid gland during TL remains to be an issue of controversy [2,3]. Most surgeons prefer to perform hemithyroidectomy (HT) on the ipsilateral side of the tumor.…”