PURPOSE OF REVIEW: To provide a critical review of recent literature on the role of tracheal resection in thyroid cancer. RECENT FINDINGS: The current body of literature is centered on the controversy regarding how radical the extent of tracheal resection needs to be to achieve long-term control of thyroid carcinoma with tracheal invasion. Proponents of shave excision are guided by the reported survival outcomes comparable to segmental resections in a selected group of patients. Others believe that all patients should have a segmental sleeve resection to ensure clearance of transmural disease. Recent advances in microsurgical reconstruction may allow selected patients to undergo tracheal resection when a large tracheal defect is anticipated. SUMMARY: Tracheal invasion by well differentiated carcinoma is a marker of a more aggressive tumor behavior, defining a subpopulation of patients at a greater risk of recurrence and death. The goal of surgical intervention in this scenario is complete resection with no gross residual disease. A well designed prospective multi-institutional trial, taking into account depth of invasion, risk group stratification, histology, presence of distant metastasis, radioactive iodine trapping ability, adjuvant treatment, and long-term survival data, is needed to compare the outcomes following more conservative shave excision and segmental tracheal resection.
PURPOSE OF REVIEW: To provide a critical review of recent literature on the role of tracheal resection in thyroid cancer. RECENT FINDINGS: The current body of literature is centered on the controversy regarding how radical the extent of tracheal resection needs to be to achieve long-term control of thyroid carcinoma with tracheal invasion. Proponents of shave excision are guided by the reported survival outcomes comparable to segmental resections in a selected group of patients. Others believe that all patients should have a segmental sleeve resection to ensure clearance of transmural disease. Recent advances in microsurgical reconstruction may allow selected patients to undergo tracheal resection when a large tracheal defect is anticipated. SUMMARY: Tracheal invasion by well differentiated carcinoma is a marker of a more aggressive tumor behavior, defining a subpopulation of patients at a greater risk of recurrence and death. The goal of surgical intervention in this scenario is complete resection with no gross residual disease. A well designed prospective multi-institutional trial, taking into account depth of invasion, risk group stratification, histology, presence of distant metastasis, radioactive iodine trapping ability, adjuvant treatment, and long-term survival data, is needed to compare the outcomes following more conservative shave excision and segmental tracheal resection.
Authors: Vincenzo Pappalardo; Stefano La Rosa; Andrea Imperatori; Nicola Rotolo; Maria Laura Tanda; Andrea Sessa; Lorenzo Dominioni; Gianlorenzo Dionigi Journal: Gland Surg Date: 2016-10
Authors: N Siddhartha Chakravarthy; Varghese Thomas; Thomas Shawn Sam; Supriya Sen; Anish Jacob Cherian; Deepak Thomas Abraham; Paul Mazhuvanchary Jacob Journal: Indian J Surg Oncol Date: 2021-08-04
Authors: Vikas Gupta; Chandrashekhar Rao; K V V N Raju; Hemantkumar Nemade; Sridhar Dasu; Y Jayakarthik; Srijan Shukla; T Subramanyeshwar Rao Journal: Indian J Surg Oncol Date: 2019-10-31