Surgical strategy for patients with papillary thyroid carcinoma invading the trachea: a comparison of tracheal sleeve resection with end-to-end anastomosis and window resection with tracheocutaneous fistula

Yukari Inoue; Aya Ebina; Kazuhisa Toda; Wataru Shimbashi; Keiko Yamada; Hiroki Mitani; Yasuhiro Tanaka; Iwao Sugitani

doi:10.21037/gs-23-171

Surgical strategy for patients with papillary thyroid carcinoma invading the trachea: a comparison of tracheal sleeve resection with end-to-end anastomosis and window resection with tracheocutaneous fistula

Gland Surg. 2023 Sep 25;12(9):1167-1178. doi: 10.21037/gs-23-171. Epub 2023 Sep 21.

Authors

Yukari Inoue¹, Aya Ebina², Kazuhisa Toda³, Wataru Shimbashi³, Keiko Yamada⁴, Hiroki Mitani³, Yasuhiro Tanaka¹, Iwao Sugitani^{2

3}

Affiliations

¹ Department of Otorhinolaryngology and Head and Neck Surgery, Dokkyo Medical University Saitama Medical Center, Saitama, Japan.
² Department of Endocrine Surgery, Nippon Medical School Graduate School of Medicine, Tokyo, Japan.
³ Division of Head and Neck, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan.
⁴ Division of Ultrasonography, Japanese Foundation for Cancer Research, Cancer Institute Hospital, Tokyo, Japan.

Abstract

Background: Sleeve resection with end-to-end anastomosis (Procedure A) and window resection with a tracheocutaneous fistula (Procedure B) are the major surgical procedures for patients with papillary thyroid carcinoma (PTC) exhibiting transluminal tracheal invasion. For each procedure, the indications, postoperative course, and treatment results were examined retrospectively.

Methods: Of 1,456 patients with PTC (maximum tumor diameter >1 cm) who received initial treatment between 1993 and 2013, we reviewed 51 patients. Of these 51 cases, 45 showed full-layer tracheal invasion, and 6 did not reach the tracheal mucosa, but required full-layer tracheal resection. Twenty-four patients underwent Procedure A, and 27 patients underwent Procedure B.

Results: Regarding surgical procedure selection, Procedure B was selected significantly more frequently than Procedure A for cases with preoperative recurrent laryngeal nerve (RLN) palsy, tumor invasion of the esophagus, clinical lymph node metastasis, or a large number of resected tracheal rings. Postoperative airway-related complications were not significantly different between the procedures, but decreased with the use of intraoperative neuromonitoring (IONM). The postoperative hospital stay was significantly longer for Procedure B than for Procedure A. In addition, the rate of a permanent postoperative tracheostoma was higher with Procedure B than with Procedure A. Local recurrence-free survival (LRFS) and cause-specific survival (CSS) did not differ significantly between the two procedures.

Conclusions: Certain patients may benefit from Procedure A with IONM in terms of a shorter hospital stay and avoiding the need for a permanent tracheostoma. Although Procedure B was indicated for patients with more advanced disease than Procedure A, treatment outcomes were similar.

Keywords: Papillary thyroid carcinoma (PTC); sleeve resection with end-to-end anastomosis; tracheal infiltration; window resection with tracheocutaneous fistula.