Surgery on the cervicovisceral axis for invasive thyroid cancer

Background and aims: Invasion of the cervicovisceral axis (i.e., larynx trachea esophagus) by thyroid cancers still poses a surgical challenge. Patients and methods: Between November 1994 and October 1999, all patients who underwent surgery at this institution for differentiated (DTC) or medullary (MTC) thyroid carcinoma invading the cervicovisceral axis were recruited into this study. Results: The cervicovisceral axis was invaded in 34 consecutive patients (19 DTC, 15 MTC). Of these, 20 patients underwent cervicovisceral resections. These resections were performed less often in MTC than in DTC patients (20% versus 89%; P <0.0001). Full-thickness invasion was present in 3 patients (2 DTC, 1 MTC). In the 20 resectional patients, tracheal wedge resection was the most common procedure followed by extramucosal esophageal resection. Surgical mortality was nil. There were five major complications, most of which occurred in either lateral tracheal or high-risk combined laryngo-tracheoesophageal resections. Conclusion: The surgical approach to invasive thyroid carcinoma must balance surgical morbidity against the potential benefits of cervicovisceral resection. Individual factors must be considered, such as patient age and co-morbidity, the extent and nature of the tumor, and quality-of-life issues, Lateral resection of the trachea may cause significant tracheal instability and morbidity and, thus, be inferior to segmental tracheal resection.