Thyroid cancer invading the airway: diagnosis and management

Avenia, Nicola; Vannucci, Jacopo; Monacelli, Massimo; Lucchini, Roberta; Polistena, Andrea; Santoprete, Stefano; Potenza, Rossella; Andolfi, Marco; Puma, Francesco

doi:10.1016/j.ijsu.2015.12.036

Cited by 36 publications

(27 citation statements)

References 10 publications

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“…Our data might be affected by the limited number of examined cases but, also based on previous experience [6], TIR3B is anyway a lesion with a significant high risk for cancer. When cancer is present, although not associated to severe prognosis since it usually shows a general benign course especially for small nodules, it remains a cancer with potential aggressiveness [26]. Emphasis must be placed on the appropriateness of care and avoidance of over-and under-treatment and mainly on avoidance of reoperation for completion thyroidectomy which is usually required, as in our series, when a TIR3B nodule is revealed as malignant at histopatology according to the international guidelines [27].…”

Section: Discussionmentioning

confidence: 85%

Follicular proliferation TIR3B: the role of total thyroidectomy vs lobectomy

et al. 2019

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Background: TIR3B thyroid nodules are considered to be at risk of malignancy (15-30%) but guidelines recommend conservative surgery with lobectomy with primary diagnostic porpoise. Risk stratification mainly based on ultrasound, elastography and genetic mutations usually may influences the surgical approach. Methods: We retrospectively analyzed 52 cases of TIR3B underwent between 2015 and 2017 total thyroidectomy (TT) and lobectomy (L), focusing mainly on the observed rate of malignancy. Chi-squared test and Fisher's exact probability test were used for analysis, considering a P values less than 0.05 as significant. Results: Out of 52 patients 49 underwent TT and 3 L. In TT group a multinodular goiter was associated in 67.3% of patients. Malignancy rate was 81.6 and 33.3% respectively after TT and L (P 0.003). Multicentric and contralateral tumors were detected respectively in 36.7% and in 32.6% of patients underwent TT. No main post-operative complications were registered. Conclusions: Ultrasound and elastography are useful to define within the TIR3B group those lesions at higher risk and therefore requiring a more radical approach. TT seems an appropriate approach to TIR3B lesions, especially in multinodular goiter, considering the incidence of malignancy with probably higher rate than previously reported.

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Section: Discussionmentioning

confidence: 85%

Follicular proliferation TIR3B: the role of total thyroidectomy vs lobectomy

et al. 2019

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“…Tracheotomy during thyroid surgery is rare due to tracheal invasion or bilateral recurrent laryngeal nerve injury. Avenia et al ( 22 ) reported that only 43 (1.9%) of 2,165 thyroid cancer patients required tracheotomy. Similar findings were also noted in the current study.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors of Postoperative Bleeding in Patients Undergoing Total Thyroidectomy

Sun

Zheng

et al. 2020

Front. Oncol.

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Purpose: Our goal was to analyze postoperative bleeding in patients undergoing total thyroidectomy and to explore the possible risk factors. Materials and Methods: Patients undergoing total thyroidectomy were retrospectively enrolled, and the main study outcomes were postoperative bleeding and 30-day mortality. Univariate and multivariate analyses were used to determine the independent risk factors for postoperative bleeding. Results: A total of 31,706 patients were enrolled for analysis during January 2010 and December 2018 from the Affiliated First Hospital of Zhengzhou University. Benign and malignant disease was reported in 4,521 and 27,185 patients, respectively. Postoperative bleeding occurred in 48 patients with benign disease and in 263 patients with malignant disease. There was one bleeding site in 243 patients. The branch of the superior thyroid artery was the most common arterial bleeding site, occurring in 124 patients, and the anterior jugular vein was the most common venous bleeding site, occurring in 85 patients. Multivariable analysis confirmed that hypertension, diabetes, BMI, and disease pathology were independent factors affecting postoperative bleeding in patients with benign disease and that hypertension, diabetes, BMI, operation time, tumor stage, and tracheotomy were independent factors affecting postoperative bleeding in patients with malignant disease. In patients with postoperative bleeding, there were 5 deaths; in patients without postoperative bleeding, there were 42 deaths, and the difference was significant ( p < 0.001). Conclusions: Compared with malignant disease patients, benign disease patients have a similar postoperative bleeding rate. A previous history of chemotherapy or radiotherapy has no significant effect on postoperative bleeding.

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“…Some studies thus may not have taken advantage of the calcifying properties of the periosteum. 2,3,10,11 If the surgery has not included a proper mobilization of the periosteum, then this may result in a soft muscular flap leading to dynamic collapse in the tracheal window. The blood supply of the SCM flap has been described by Kierner et al 12 If the circulation is compromised due to an inadequate amount of vascularized muscle attached to the periosteal flap, then this may also lead to unsatisfactory results in terms of establishing a stable airway.…”

Section: Surgical Notesmentioning

confidence: 99%

From the clavicle to the windpipe: Tracheal window resections reconstructed with calcifying periosteum in thyroid cancer

Lorntzsen

Brøndbo

Osnes

2020

Laryngoscope Investig Oto

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Objectives: We aimed to evaluate the outcomes of tracheal window resection and reconstruction using a vascularized periosteal flap (intended for calcification) harvested from the medial clavicle. This is one of several surgical techniques for tracheal resection and reconstruction used for patients with thyroid carcinoma invading the trachea. Importantly, in partial tracheal resection postoperative dynamic airway collapse must be prevented. Reconstruction of the tracheal defect with a vascularized periosteal flap is one method of achieving a stable airway. Methods: Twelve patients with locally advanced thyroid carcinoma who underwent tracheal resection and reconstruction at Oslo University Hospital from 2004 to 2017 were studied retrospectively. The primary outcome was a stable airway not requiring airway stenting. The secondary outcomes were the time to decannulation, morbidity, and survival. Results: Eleven of 12 patients did not require airway stenting postoperatively after a median of 111 days. Seven patients developed postoperative complications. The median observation time was 74.8 months (range 10.5-153.5) for all patients. The median disease-free survival was 40 months (range 0-147). By February 1, 2020, seven patients were alive, of whom five showed no evidence of disease. Conclusions: Tracheal reconstruction with a vascularized periosteal flap yielded good results in terms of establishing a stable airway. This procedure is a viable reconstructive option that allows for decannulation by preventing airway collapse, thereby potentially mitigating the need for end-to-end (ETE) anastomosis or sleeve resections. For selected patients, this procedure may prevent local fatal complications from thyroid cancer invading the trachea.

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Thyroid cancer invading the airway: diagnosis and management

Abstract: Although some patients are currently referred with a severely advanced disease, the indication for tracheotomy, salvage procedures or supportive care has decreased over time. Resection is feasible for differentiated tumors with an overall good outcome.

Cited by 36 publications

References 10 publications

Follicular proliferation TIR3B: the role of total thyroidectomy vs lobectomy

Follicular proliferation TIR3B: the role of total thyroidectomy vs lobectomy

Incidence and Risk Factors of Postoperative Bleeding in Patients Undergoing Total Thyroidectomy

From the clavicle to the windpipe: Tracheal window resections reconstructed with calcifying periosteum in thyroid cancer

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