Department of General, Visceral and Vascular Surgery, University Hospital Halle, Germany.
Surgery. 2010 Dec;148(6):1257-66. doi: 10.1016/j.surg.2010.09.011.
The appropriate resection for thyroid cancer invading the aerodigestive tract remains controversial.
A total of 174 patients underwent resections for aerodigestive tract invasion from differentiated thyroid cancer (103 patients), medullary thyroid cancer (40 patients), and undifferentiated thyroid cancers/unusual thyroid neoplasms (31 patients). In all, 82 patients submitted to transmural resections (window resection, sleeve resection, or cervical evisceration), 65 patients underwent nontransmural resections (shaving or extramucosal esophageal resections), and 27 patients had grossly incomplete resections. The measures of outcome included surgical morbidity, locoregional recurrence, and disease-specific survival.
Surgical morbidity was 38% after transmural and 25% after nontransmural resection (P = .02). On histopathologic examination, surgical margins were microscopically involved in 9% of patients after transmural and 23% of patients after nontransmural resection (P = .014). At a mean follow-up of 35.3 months, locoregional recurrence developed in 10 (46%) of 22 patients with microscopically incomplete and 18 (15%) of 121 patients with microscopically complete resection (P = .001). After grossly complete resection, the mean disease-specific survival was 101.2, 69.8, and 25.5 months for differentiated thyroid cancer, medullary thyroid cancer, and undifferentiated thyroid cancer/unusual neoplasms, respectively (P < .001). This outcome was independent of the type of resection.
The type of cancer and resection are key determinants of outcome among thyroid cancer patients with aerodigestive tract invasion.
甲状腺癌侵犯呼吸道和消化道的适当切除方法仍存在争议。
共有 174 例患者因分化型甲状腺癌（103 例）、甲状腺髓样癌（40 例）和未分化甲状腺癌/罕见甲状腺肿瘤（31 例）接受了呼吸道和消化道侵犯切除术。总共 82 例患者接受了贯穿壁切除术（窗切除术、袖状切除术或颈廓清术），65 例患者接受了非贯穿壁切除术（刮除术或黏膜外食管切除术），27 例患者接受了大体上不完全切除术。结果的评估包括手术发病率、局部区域复发和疾病特异性生存率。
贯穿壁切除术后的手术发病率为 38%，非贯穿壁切除术后为 25%（P =.02）。在组织病理学检查中，贯穿壁切除术后 9%的患者手术切缘显微镜下受累，而非贯穿壁切除术后 23%的患者手术切缘显微镜下受累（P =.014）。在平均 35.3 个月的随访中，22 例显微镜下不完全切除的患者中有 10 例（46%）和 121 例显微镜下完全切除的患者中有 18 例（15%）发生局部区域复发（P =.001）。在大体上完全切除后，分化型甲状腺癌、甲状腺髓样癌和未分化甲状腺癌/罕见肿瘤的患者的疾病特异性生存率分别为 101.2、69.8 和 25.5 个月（P <.001）。这一结果与切除类型无关。
在有呼吸道和消化道侵犯的甲状腺癌患者中，癌症类型和切除方式是决定预后的关键因素。
