Management of thyroid carcinoma invading the aero-digestive tract
Keywords:
thyroid, neoplasms, surgery, therapyAbstract
Objective: To compare survival of patients with thyroid cancer invading the proximal aerodigestive tract, treated either by conservative or by radical surgery.
Introduction: Thyroid cancer usually follows a benign course; however, when surrounding structures, such as proximal airways or the digestive tract, are invaded by the primary tumor, its outcome may be unfavorable. Since cases referred to the National Cancer Institute of Colombia are frequently advanced, we undertook a retrospective study to review our experience at the Head and Neck Department.
Methods: We reviewed the clinical records from 510 patients operated in our Institute for thyroid cancer between January 1994 and March 2002. Patients with tumor invasion of the proximal aerodigestive tract were divided into two groups: those treated by tumor shaving surgery were placed in group I, whereas those treated by more radical surgery were included in group II.
Results: A total of 50 patients were finally included: 24 in group I, and 26 in group II. Both positive tumor margins and tumor persistence were more frequently found in group I patients (83,3% and 37,5%) than in group II patients (26,9% [p = 0.000], and 3,8% [p = 0,003], respectively). Local recurrence was 13.3% in group I patients, and 8% in group II patients (p = 0,586). Surgical morbidity was similar in both groups (45,8% vs. 51,1% [p - 0,402]), but surgical complications were more often seen in group II patients (57,7% vs. 29,2% [p = 0,042]). Once controlled for confounding factors, no differences were found for patient survival between the two groups by using the Cox regression model.
Conclusions: Despite a higher rate of complications among group II patients, we recommend radical surgery for thyroid cancer invading the aero-digestive tract, because it reduces tumor persistence and improves local control.
Author Biographies
Enrique Cadena, Instituto Nacional de Cancerología
Instituto Nacional de Cancerología, Grupo Cirugía Cabeza y Cuello, E.S.E., Bogotá, D.C., Colombia.
Brígida Martínez, Colegio Mayor de Nuestra Señora del Rosario
Colegio Mayor de Nuestra Señora del Rosario, Departamento de Cirugía General, Bogotá, D.C., Colombia.
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