TRACHEAL
INVASION IN DIFFERENTIATED THYROID CANCER
Tracheal
invasion by well-differentiated thyroid cancer (DTC), usually in cases of
locoregional recurrence, severely aggravates prognosis. Half of the fatal cases
of DTC is caused by tracheal invasion/obstruction. In the past, palliative
surgery (usually ‘shaving’ the tumor off the tracheal wall) was the only surgical
treatment option in these cases, but it was associated with high recurrence
rates. Recent advances in tracheal surgery allow local resection of the trachea
with primary anastomosis in selected patients. Currently, radical resection of
locoregional disease with concomitant tracheal resection and primary
anastomosis is the surgical treatment of choice for the management of DTC with
tracheal infiltration when there is mucosal invasion. In contrast, when the
tumor is confined to the tracheal wall, the technique of ‘shaving’ the tumor
off the trachea should be preferred. Prognosis is these cases is more
favorable. Accurate estimation of the extent of tracheal wall involvement (typically
using bronchoscopy and computed tomography or magnetic resonance imaging) is
required to achieve radical resection. Frozen sections of the tracheal margins
should be performed at the time of surgery. Tracheal resection and primary
anastomosis at the time of radical resection of locoregional disease can achieve
long-term survival and possible cures. Adjuvant postoperative radioiodine
therapy or external beam radiation therapy (EBRT) may further improve
therapeutic results. Extensive tracheal involvement is a contraindication for tracheal
resection and primary anastomosis.
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