Ayşegül BATIOĞLU KARAALTIN, Murat Haydar YENER, Mehmet YILMAZ, Nesrettin Fatih TURGUT, Muhammed PAMUKÇU, Harun CANSIZ

Larengotrakeal invazyonlu ileri tiroid karsinomunun tedavisi

Amaç: Bu çalışmada ekstra tiroidal uzantılı ileri tiroid karsinomunun tedavisi değerlendirildi.Hastalar ve Yöntemler: Çalışmaya genel cerrahi veya diğer kulak-burun-boğaz bölümlerinden sevk edilen ve Ocak 2007 - Ocak 2011 tarihleri arasında T4a iyi diferansiye tiroid karsinomu veya T4b anaplastik karsinomu nedeniyle cerrahi geçiren, en az beş yıl takip edilen 58 hasta 26 erkek, 32 kadın; ort. yaş 45.1±8.3 yıl; dağılım 24-72 yıl dahil edildi. Larengotrakeal invazyonu olan hastalar cerrahi türüne göre iki gruba ayrıldı. İnvazyon paternleri ve cerrahi rezeksiyon teknikleri değerlendirildi.Bulgular: Grup 1’deki hastaların n=24 tamamına %100 total tiroidektomi, altısına %10.4 parsiyel larenjektomi, sekizine %13 trakeal rezeksiyon ve 16’sına %27 trakeal pencere rezeksiyonu uygulandı; serbest marjinler dondurulmuş kesit ile doğrulandı. Grup 2’deki hastalara n=34 tümörü alttaki kıkırdaktan kazıyarak veya larengotrakeal segmentleri iskeletleştirerek total tiroidektomi %100 uygulandı. Takip dönemi sırasında, bir hasta karotis tutulumu ve dört hasta lokal rekürens nedeniyle kaybedildi.Sonuç: Bu çalışmanın bulguları ekstra tiroidal uzantılı ileri tiroid karsinomlu hastalar için cerrahi bir yaklaşım seçilirken invazyon derinliğinin ve ameliyat sonrası morbiditenin dikkate alınması gerektiğini ortaya koymaktadır. Ayrıca, tümör kazıması geçiren hastalar yakından takip edilmelidir

Anahtar Kelimeler:

Ekstra tiroidal uzantı, segmental larengotrakeal rezeksiyon, tiroid karsinomu

Management of advanced thyroid carcinoma with laryngotracheal invasion

Objectives: This study aims to evaluate the management of advanced thyroid carcinoma with extra-thyroidal extension. Patients and Methods: The study included 58 patients 26 males, 32 females; mean age 45.1±8.3 years; range 24 to 72 years who were referred from general surgery or other otolaryngology departments and had undergone surgery for T4a well-differentiated thyroid carcinoma or T4b anaplastic carcinoma between January 2007 and January 2011 with a minimum of five years of follow-up. The patients with laryngotracheal invasion were divided into two groups according to type of surgery. Patterns of invasion and techniques of surgical resection were evaluated. Results: Of the patients in group 1 n=24 , total thyroidectomy was performed in all 100% , partial laryngectomy in six 10.4% , tracheal resection in eight 13% , and tracheal window resection in 16 27% , and the free margins were verified by frozen section. Patients in group 2 n=34 were performed total thyroidectomy 100% by shaving the tumor off the underlying cartilage or skeletonizing laryngotracheal segments. During the follow-up period, one patient died because of carotid involvement and four patients died because of local recurrence. Conclusion: The results of this study suggest that the depth of the invasion and postoperative morbidity should be considered when choosing a surgical approach for patients with advanced thyroid carcinoma with extra-thyroidal extension. Also, patients who undergo tumor shaving should be followed-up closely.

Keywords:

Extra-thyroidal extension, segmental laryngotracheal resection, thyroid carcinoma,

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