Tracheal and Crico-Tracheal Resection and Anastomosis for Malignancies Involving the Thyroid Gland and the Airway

Ann Otol Rhinol Laryngol. 2016 Feb;125(2):97-104. doi: 10.1177/0003489415599000. Epub 2015 Aug 20.

Abstract

Objectives: To evaluate outcomes in different malignancies involving the thyroid and infiltrating the airway submitted to tracheal (TRA) or crico-tracheal resection and anastomosis (CTRA).

Methods: Retrospective charts review of 27 patients affected by thyroid malignancies involving the airway treated by TRA/CTRA in a single academic institution. Kaplan-Meier curves were used to evaluate the overall (OS) and disease-specific (DSS) survivals and local (LC) and loco-regional control (LRC). Impact on survival of age, comorbidities, previous radiotherapy, types of TRA/CTRA, Shin's stage (II, III, IV), grading (well vs poorly differentiated), and length of airway resected was calculated by the log-rank test.

Results: Overall survival and DSS at 3 and 5 years were 82.3% and 71.6%, respectively. Local control and LRC in the entire group were 82.3% at 3 and 5 years. Crico-tracheal resection and anastomosis involving the cricoid arch and plate (type C) and tumor differentiation significantly affected OS and DSS (both P < .001). Type C CTRA and tumor differentiation significantly impacted on LC (P = .002 and P = .009, respectively).

Conclusions: Grading and extension of CTRA to the cricoid plate are the most important factors for oncologic outcomes in thyroid malignancies infiltrating the airway. Except for poorly differentiated tumors, TRA/CTRA allows adequate LC even in advanced stage lesions involving the crico-tracheal junction.

Keywords: airway; anastomosis; cricoid; resection; thyroid cancer; trachea.

MeSH terms

  • Aged
  • Airway Obstruction* / diagnosis
  • Airway Obstruction* / etiology
  • Airway Obstruction* / surgery
  • Anastomosis, Surgical / methods*
  • Biopsy, Fine-Needle / methods
  • Cricoid Cartilage* / pathology
  • Cricoid Cartilage* / surgery
  • Endoscopy / methods
  • Female
  • Follow-Up Studies
  • Humans
  • Italy / epidemiology
  • Kaplan-Meier Estimate
  • Magnetic Resonance Imaging / methods
  • Male
  • Middle Aged
  • Neoplasm Invasiveness
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Retrospective Studies
  • Thyroid Neoplasms* / complications
  • Thyroid Neoplasms* / diagnosis
  • Thyroid Neoplasms* / mortality
  • Thyroid Neoplasms* / pathology
  • Thyroid Neoplasms* / surgery
  • Thyroidectomy* / adverse effects
  • Thyroidectomy* / methods
  • Tomography, X-Ray Computed / methods
  • Trachea* / pathology
  • Trachea* / surgery
  • Tracheotomy / adverse effects
  • Tracheotomy / methods
  • Treatment Outcome