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A novel procedure for transtracheal resection for recurrent thyroid cancer involving a trachea and esophagus.

Ohba S, Yokoyama J, Fujimaki M, Kojima M, Ikeda K - World J Surg Oncol (2014)

Bottom Line: To decrease the potential for recurrent laryngeal nerve injuries and to preserve both the tracheal and esophageal blood supply, we adapted a transtracheal approach; the recurrent tumor was safely and completely removed without causing a dysfunction.Furthermore, the risk of bleeding from major lateral vessels was reduced.This new procedure for transtracheal resection for recurrent thyroid cancer involving the trachea and esophagus was useful and safe.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan. jyokoya@juntendo.ac.jp.

ABSTRACT

Background: Surgery remains the main treatment for locally advanced thyroid cancers invading the trachea, esophagus, and recurrent laryngeal nerve. However, extensive resection of such tumors can sometimes involve difficulties and may result in the deterioration of the patient's quality of life. The surgeon should consider not only the patient's prognosis but also the preservation of postoperative function.

Methods: This report describes a minimally invasive surgical procedure for recurrent poorly differentiated papillary thyroid carcinoma involving the trachea and esophagus. To decrease the potential for recurrent laryngeal nerve injuries and to preserve both the tracheal and esophageal blood supply, we adapted a transtracheal approach; the recurrent tumor was safely and completely removed without causing a dysfunction. After a tracheotomy to the right, the tumor was easily detected through the tracheostoma and delineated by palpation. The mucous membrane of the trachea was minimally incised along the right-hand border of the tumor and a mucosal flap was elevated. The left side of the trachea including the membranous wall and cartilage of the tracheal mucosa was maximally preserved, to maintain the vascular supply to the trachea. Finally, the membranous wall of the trachea was preserved to within one-third of the left-hand side. Furthermore, the risk of bleeding from major lateral vessels was reduced. A sternocleidomastoid muscle flap was elevated and inserted into the cavity resulting from the tumor resection and sutured between the esophagus and trachea. The membranous wall of the tracheal mucosa was also sutured submucosally.

Results: The tumor was removed completely with the muscular layer of the esophagus without injury to the intact recurrent laryngeal nerve and lateral major vessels. The patient started oral nutritional intake on the first postoperative day and was discharged without any significant postoperative complications.

Conclusions: This new procedure for transtracheal resection for recurrent thyroid cancer involving the trachea and esophagus was useful and safe.

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Surgical procedure and postoperative endotracheal finding. (A) Surgical procedure. (B) Endotracheal finding 3 months after the surgery. There is no granulation formation. Arrow indicates the left-hand end of the surgical scar on the membranous wall of the trachea.
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Fig4: Surgical procedure and postoperative endotracheal finding. (A) Surgical procedure. (B) Endotracheal finding 3 months after the surgery. There is no granulation formation. Arrow indicates the left-hand end of the surgical scar on the membranous wall of the trachea.

Mentions: A 69-year-old woman with a past surgical history for a poorly differentiated thyroid cancer presented with a 2 × 2 cm mass between the trachea and the esophagus. The patient already had right recurrent laryngeal palsy from the first treatment. This recurrence was detected by computed tomography (CT), and was shown to be rapidly enlarging over the course of two months (Figure 1). The lesion was also examined by fluorodeoxyglucose (FDG) positron emission tomography (PET), which showed high FDG uptake (maximum standardized uptake value, 15.45) and demonstrated a recurrence of thyroid cancer (Figure 2). After providing written informed consent, the patient underwent surgical resection of the recurrent thyroid cancer with the new procedure. The patient was positioned under general anesthesia in a supine position on the operating table with her neck hyperextended. Through a transverse cervical incision made just along the previous surgical scar, a tracheotomy was performed. The tumor was easily detected through the tracheostoma, then delineated by palpation. The mucous membrane of the trachea was minimally incised along the right-hand border of the tumor and a mucosal flap was elevated (Figure 3). The left-hand side of the trachea including the membranous wall and cartilage of the tracheal mucosa was maximally preserved, to maintain the vascular supply to the trachea. Finally, the membranous wall of the trachea was preserved to within one-third of the left-hand side (Figure 4A). Bleeding from both cut edges of the tracheal mucosa was confirmed. There was no extracapsular spread and the tumor was removed completely with the muscular layer of the esophagus. Intraoperative frozen examination revealed that the tumor was completely resected. A right sternocleidomastoid muscle flap was elevated and inserted into the cavity resulting from the tumor resection and sutured between the esophagus and the trachea. The membranous wall of the tracheal mucosa was also sutured submucosally. A temporary tracheocutaneous stoma was made.Figure 1


A novel procedure for transtracheal resection for recurrent thyroid cancer involving a trachea and esophagus.

Ohba S, Yokoyama J, Fujimaki M, Kojima M, Ikeda K - World J Surg Oncol (2014)

Surgical procedure and postoperative endotracheal finding. (A) Surgical procedure. (B) Endotracheal finding 3 months after the surgery. There is no granulation formation. Arrow indicates the left-hand end of the surgical scar on the membranous wall of the trachea.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4197303&req=5

Fig4: Surgical procedure and postoperative endotracheal finding. (A) Surgical procedure. (B) Endotracheal finding 3 months after the surgery. There is no granulation formation. Arrow indicates the left-hand end of the surgical scar on the membranous wall of the trachea.
Mentions: A 69-year-old woman with a past surgical history for a poorly differentiated thyroid cancer presented with a 2 × 2 cm mass between the trachea and the esophagus. The patient already had right recurrent laryngeal palsy from the first treatment. This recurrence was detected by computed tomography (CT), and was shown to be rapidly enlarging over the course of two months (Figure 1). The lesion was also examined by fluorodeoxyglucose (FDG) positron emission tomography (PET), which showed high FDG uptake (maximum standardized uptake value, 15.45) and demonstrated a recurrence of thyroid cancer (Figure 2). After providing written informed consent, the patient underwent surgical resection of the recurrent thyroid cancer with the new procedure. The patient was positioned under general anesthesia in a supine position on the operating table with her neck hyperextended. Through a transverse cervical incision made just along the previous surgical scar, a tracheotomy was performed. The tumor was easily detected through the tracheostoma, then delineated by palpation. The mucous membrane of the trachea was minimally incised along the right-hand border of the tumor and a mucosal flap was elevated (Figure 3). The left-hand side of the trachea including the membranous wall and cartilage of the tracheal mucosa was maximally preserved, to maintain the vascular supply to the trachea. Finally, the membranous wall of the trachea was preserved to within one-third of the left-hand side (Figure 4A). Bleeding from both cut edges of the tracheal mucosa was confirmed. There was no extracapsular spread and the tumor was removed completely with the muscular layer of the esophagus. Intraoperative frozen examination revealed that the tumor was completely resected. A right sternocleidomastoid muscle flap was elevated and inserted into the cavity resulting from the tumor resection and sutured between the esophagus and the trachea. The membranous wall of the tracheal mucosa was also sutured submucosally. A temporary tracheocutaneous stoma was made.Figure 1

Bottom Line: To decrease the potential for recurrent laryngeal nerve injuries and to preserve both the tracheal and esophageal blood supply, we adapted a transtracheal approach; the recurrent tumor was safely and completely removed without causing a dysfunction.Furthermore, the risk of bleeding from major lateral vessels was reduced.This new procedure for transtracheal resection for recurrent thyroid cancer involving the trachea and esophagus was useful and safe.

View Article: PubMed Central - PubMed

Affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo 113-8421, Japan. jyokoya@juntendo.ac.jp.

ABSTRACT

Background: Surgery remains the main treatment for locally advanced thyroid cancers invading the trachea, esophagus, and recurrent laryngeal nerve. However, extensive resection of such tumors can sometimes involve difficulties and may result in the deterioration of the patient's quality of life. The surgeon should consider not only the patient's prognosis but also the preservation of postoperative function.

Methods: This report describes a minimally invasive surgical procedure for recurrent poorly differentiated papillary thyroid carcinoma involving the trachea and esophagus. To decrease the potential for recurrent laryngeal nerve injuries and to preserve both the tracheal and esophageal blood supply, we adapted a transtracheal approach; the recurrent tumor was safely and completely removed without causing a dysfunction. After a tracheotomy to the right, the tumor was easily detected through the tracheostoma and delineated by palpation. The mucous membrane of the trachea was minimally incised along the right-hand border of the tumor and a mucosal flap was elevated. The left side of the trachea including the membranous wall and cartilage of the tracheal mucosa was maximally preserved, to maintain the vascular supply to the trachea. Finally, the membranous wall of the trachea was preserved to within one-third of the left-hand side. Furthermore, the risk of bleeding from major lateral vessels was reduced. A sternocleidomastoid muscle flap was elevated and inserted into the cavity resulting from the tumor resection and sutured between the esophagus and trachea. The membranous wall of the tracheal mucosa was also sutured submucosally.

Results: The tumor was removed completely with the muscular layer of the esophagus without injury to the intact recurrent laryngeal nerve and lateral major vessels. The patient started oral nutritional intake on the first postoperative day and was discharged without any significant postoperative complications.

Conclusions: This new procedure for transtracheal resection for recurrent thyroid cancer involving the trachea and esophagus was useful and safe.

Show MeSH
Related in: MedlinePlus