Ebihara Mitsuru, Kishimoto Seiji, Hayashi Ryuichi, Miyazaki Masakazu, Shinozaki Takeshi, Daiko Hiroyuki, Saikawa Masahisa, Sakuraba Minoru, Miyamoto Shinpei
Department of Head and Neck Surgery, National Cancer Center Hospital East, Japan.
Auris Nasus Larynx. 2011 Apr;38(2):271-5. doi: 10.1016/j.anl.2010.09.003. Epub 2010 Nov 18.
In cases of differentiated thyroid carcinoma, the presence or absence of invasion into the circumferential organs is an important prognostic factor. Surgical procedures include circular resection of the trachea with end-to-end anastomosis and window resection with secondary closure. We have used window resection with secondary closure since 1993, and herein retrospectively analyze the treatment outcomes for this surgical procedure in order to determine the indications for procedure selection.
Subjects comprised 41 cases of invasion by differentiated thyroid carcinoma into the trachea, for which surgery was performed at the Department of Head and Neck Surgery of the National Cancer Center Hospital East from 1993 to 2007. The mean age was 65.7±7.9 years, and the median length of the observation period was 43 months. There were 17 cases (41.4%) cases of secondary relapse.
The 5-year and 10-year overall survival rates for this surgical procedure were 78.9% and 74.5%, respectively, while the 5-year and 10-year local control rates were 92.4% and 73.4%, respectively. The pathological resection stump was positive in 27 cases (65.8%), but no significant differences in treatment outcome were observed between the stump-positive group and the stump-negative group. There were 26 cases in which closure of the tracheal fistula was performed by the time of observation. When the tracheal defect had a diameter equivalent to 7 rings of the trachea or less and a circumference half that of the tracheal cartilage or smaller, including partial cricoid cartilage, it was possible to perform closure with only a local flap. For larger defects, reconstruction was performed using hard tissues or materials, such as hydroxyapatite, titanium mesh, and costal cartilage. There were 2 cases that required re-window because of dyspnea after closure.
The treatment outcomes for this surgical procedure for invasive cases of differentiated thyroid carcinoma into the trachea resulted in a low rate of local recurrence and similar survival rates as described in other reports. Even for cases of resection exceeding half the circumference of the trachea, closure of the tracheal fistula can be performed using hard tissues or materials; however, in such cases, we believe that closure should be attempted progressively in a two-stage reconstruction.
在分化型甲状腺癌病例中，是否侵犯周围器官是一个重要的预后因素。手术方式包括气管环形切除端端吻合术和开窗切除二期缝合术。自1993年以来我们一直采用开窗切除二期缝合术，在此对该手术方式的治疗结果进行回顾性分析，以确定手术方式选择的适应证。
研究对象包括41例分化型甲状腺癌侵犯气管的病例，于1993年至2007年在国立癌症中心东医院头颈外科接受手术治疗。平均年龄为65.7±7.9岁，中位观察期为43个月。有17例（41.4%）出现二次复发。
该手术方式的5年和10年总生存率分别为78.9%和74.5%，5年和10年局部控制率分别为92.4%和73.4%。病理切除切缘阳性27例（65.8%），但切缘阳性组与切缘阴性组的治疗结果无显著差异。观察时26例进行了气管瘘闭合。当气管缺损直径相当于气管7个环及以下且周长为气管软骨周长的一半及更小，包括部分环状软骨时，仅用局部皮瓣即可完成闭合。对于较大的缺损，使用硬组织或材料如羟基磷灰石、钛网和肋软骨进行重建。有2例因闭合后呼吸困难需要再次开窗。
该手术方式治疗分化型甲状腺癌侵犯气管的病例，局部复发率低，生存率与其他报道相似。即使对于气管切除超过周长一半的病例，也可使用硬组织或材料进行气管瘘闭合；然而，在这种情况下，我们认为应分两阶段逐步尝试进行闭合重建。
