Brauckhoff M, Dralle H
Department of Surgical Sciences, University of Bergen, Norway.
Chirurg. 2011 Feb;82(2):134-40. doi: 10.1007/s00104-010-1975-6.
Extrathyroidal thyroid cancer invading the laryngotracheal system (UICC stage pT4a) represents a progressive process of infiltration of the tracheal wall layers from the outer to the inner parts of the trachea. These tumors usually present with high proliferation activity correlating with a reduced long-term prognosis. In contrast to intraluminal manifestation requiring complete wall resection, in cases of non-transmural invasion, complete tumor removal can be sometimes achieved by extraluminal tangential resection (shaving). Tangential resections, however, are associated with a higher frequency of microscopically invaded resection margins (R1 resection rate >40%). The available comparative studies (all retrospective, maximum EBM level 3) analyzing oncological outcome show inconsistent results. In more recently published studies, however, complete wall resection in well-differentiated thyroid cancer with tracheal invasion only was found to be associated with longer recurrence-free and tumor-specific survival when compared to shaving. Deep larynx invasion is associated with reduced long-term prognosis when compared to invasion of the trachea. Salvage resections should therefore be performed in selected cases only.
侵犯喉气管系统的甲状腺外甲状腺癌（UICC分期pT4a）表现为肿瘤从气管外壁向内壁逐渐浸润的过程。这些肿瘤通常具有较高的增殖活性，与长期预后不良相关。与需要完整切除气管壁的腔内表现不同，在非透壁性侵犯的情况下，有时可通过腔外切线切除（削除术）实现肿瘤的完整切除。然而，切线切除与显微镜下切缘受侵的频率较高相关（R1切除率>40%）。分析肿瘤学结局的现有比较研究（均为回顾性研究，最高循证医学水平为3级）结果不一致。然而，在最近发表的研究中，发现仅侵犯气管的高分化甲状腺癌行完整气管壁切除与削除术相比，无复发生存期和肿瘤特异性生存期更长。与气管侵犯相比，深部喉侵犯与长期预后较差相关。因此，仅在选定的病例中进行挽救性切除。
