Surgical resources in advanced thyroid cancer treatment with aerodigestive tract invasion.
Male
Female
Humans
Middle Aged
Aged
Thyroid Cancer, Papillary
/ surgery
Positron Emission Tomography Computed Tomography
Iodine Radioisotopes
Quality of Life
Carcinoma, Papillary
/ pathology
Lymphatic Metastasis
Thyroid Neoplasms
/ surgery
Thyroidectomy
/ methods
Neck Dissection
/ methods
Lymph Nodes
/ pathology
Retrospective Studies
Journal
Surgical oncology
ISSN: 1879-3320
Titre abrégé: Surg Oncol
Pays: Netherlands
ID NLM: 9208188
Informations de publication
Date de publication:
Feb 2023
Feb 2023
Historique:
received:
03
09
2022
accepted:
02
10
2022
pubmed:
22
12
2022
medline:
25
2
2023
entrez:
21
12
2022
Statut:
ppublish
Résumé
Despite papillary thyroid cancer (PTC) excellent prognosis, 10-15% of patients may present aggressive local behaviour. We present two cases with different aerodigestive tract invasion partners in which two reconstructions were used, out of all the surgical resources we have planned preoperatively [1-4]. Case 1: 57-year-old woman with asymmetric goitre and a 60mm nodule (Bethesda-VI). CT showed suspected involvement of aero-digestive tract. Endobronchial ultrasound (EBUS) showed no tracheal invasion. Per oral endoscopic-US confirmed transmural oesophageal involvement. Surgery included total thyroidectomy(left recurrent laryngeal nerve was sacrificed), bilateral central and left lateral lymph node dissection, oesophageal partial resection and reconstruction with free radial flap. Case 2: 75-year-old male with cervical mass and haemoptysis. US showed a 62 mm nodule (Bethesda-VI). PET-CT showed tracheal invasion(bronchoscopy confirmatory). Per oral endoscopic-US showed no transmural oesophageal involvement. Surgery included total thyroidectomy (right recurrent laryngeal nerve was sacrificed), bilateral central lymph node dissection, tracheal resection and extra-mucosal oesophageal resection. First patient required tracheostomy. She presented a self-limiting salivary fistula. She was discharged after 6 weeks with good oral intake and tracheostomy closed. Pathology report showed multifocal papillary thyroid cancer(tall cells, 70mm),micro-metastatic lymph node involvement. Afterwards, radioiodine ablation was performed. Six months after surgery there was no evidence of structural disease and analysis showed Tg 1 μg/L. Second patient developed nosocomial pneumonia and was discharged after 3 weeks. Pathology report showed papillary thyroid cancer (insular growth, 52 mm), bilateral neck central lymph nodes involvement, transmural tracheal infiltration, free margins. Radioiodine ablation is pending. Surgical treatment of advanced/invasive PTC offers good results in terms of survival and quality of life. Adequate pre-surgical planning, which includes multiple surgical resources, and a multidisciplinary team approach are required.
Sections du résumé
BACKGROUND
BACKGROUND
Despite papillary thyroid cancer (PTC) excellent prognosis, 10-15% of patients may present aggressive local behaviour. We present two cases with different aerodigestive tract invasion partners in which two reconstructions were used, out of all the surgical resources we have planned preoperatively [1-4].
METHODS
METHODS
Case 1: 57-year-old woman with asymmetric goitre and a 60mm nodule (Bethesda-VI). CT showed suspected involvement of aero-digestive tract. Endobronchial ultrasound (EBUS) showed no tracheal invasion. Per oral endoscopic-US confirmed transmural oesophageal involvement. Surgery included total thyroidectomy(left recurrent laryngeal nerve was sacrificed), bilateral central and left lateral lymph node dissection, oesophageal partial resection and reconstruction with free radial flap. Case 2: 75-year-old male with cervical mass and haemoptysis. US showed a 62 mm nodule (Bethesda-VI). PET-CT showed tracheal invasion(bronchoscopy confirmatory). Per oral endoscopic-US showed no transmural oesophageal involvement. Surgery included total thyroidectomy (right recurrent laryngeal nerve was sacrificed), bilateral central lymph node dissection, tracheal resection and extra-mucosal oesophageal resection.
RESULTS
RESULTS
First patient required tracheostomy. She presented a self-limiting salivary fistula. She was discharged after 6 weeks with good oral intake and tracheostomy closed. Pathology report showed multifocal papillary thyroid cancer(tall cells, 70mm),micro-metastatic lymph node involvement. Afterwards, radioiodine ablation was performed. Six months after surgery there was no evidence of structural disease and analysis showed Tg 1 μg/L. Second patient developed nosocomial pneumonia and was discharged after 3 weeks. Pathology report showed papillary thyroid cancer (insular growth, 52 mm), bilateral neck central lymph nodes involvement, transmural tracheal infiltration, free margins. Radioiodine ablation is pending.
CONCLUSIONS
CONCLUSIONS
Surgical treatment of advanced/invasive PTC offers good results in terms of survival and quality of life. Adequate pre-surgical planning, which includes multiple surgical resources, and a multidisciplinary team approach are required.
Identifiants
pubmed: 36542909
pii: S0960-7404(22)00158-X
doi: 10.1016/j.suronc.2022.101863
pii:
doi:
Substances chimiques
Iodine Radioisotopes
0
Types de publication
Case Reports
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
101863Informations de copyright
Copyright © 2022. Published by Elsevier Ltd.
Déclaration de conflit d'intérêts
Declaration of competing interest Authors don't have any conflict of interest to declare and no funding source have been employed.