Chala A I, Vélez S, Sanabria A
Head and Neck Surgery Service, School of Medicine, Universidad de Caldas, Manizales, Colombia.
School of Medicine. Universidad de Antioquia, Medellín, Colombia.
Acta Otorhinolaryngol Ital. 2018 Apr;38(2):109-114. doi: 10.14639/0392-100X-1191.
Locally advanced disease with larynx invasion is a challenge to the surgeon, but laryngectomy is almost never necessary in thyroid carcinoma. The aim of this study was to review the clinical outcomes of patients with locally advanced thyroid carcinoma invading the larynx who underwent laryngectomy. A case series of patients treated in a tertiary care hospital was reviewed. Data about the type of operation, method of reconstruction, complications and overall survival of 16 patients operated on between 2002 and 2015 with larynx invasion is presented. There were 10 females. The mean age was 63 ± 8.8 years. Besides total thyroidectomy and neck dissection, four patients underwent total pharyngolaryngectomy, 11 total laryngectomy and one hemi-laryngectomy. Reconstruction was made with regional flaps in 10 patients (7 pectoral/Bakamjian flaps and 3 gastric pull-through procedures) and a jejunum free flap in one patient. Two patients needed carotid artery reconstruction. Five tumours were classic (conventional) papillary carcinoma variants, while the others were aggressive histological varieties (insular, tall cell, sclerosing). The mean tumour size was 4.3 ± 1.6 cm. All tumours had lymphovascular invasion and 12 had positive lymph nodes. Concomitantly, oesophageal/hypopharyngeal invasion was present in 7 cases and invasion of carotid vessels in 2 cases. There were two postoperative deaths and two anastomotic leaks that were treated conservatively. The mean overall survival was 31 ± 33 months (median 27.6 months, range 0-120). Laryngectomy is an alternative surgical procedure to control selected cases of advanced thyroid carcinoma that offers good local control and long term survival.
局部晚期伴有喉侵犯的疾病对外科医生来说是一项挑战，但甲状腺癌几乎从不需行喉切除术。本研究的目的是回顾接受喉切除术的局部晚期侵犯喉的甲状腺癌患者的临床结局。回顾了在一家三级医疗中心接受治疗的一系列病例。呈现了2002年至2015年间接受手术的16例伴有喉侵犯患者的手术类型、重建方法、并发症及总生存数据。其中女性10例。平均年龄为63±8.8岁。除全甲状腺切除术和颈部清扫术外，4例患者接受了全喉咽切除术，11例接受了全喉切除术，1例接受了半喉切除术。10例患者（7例采用胸大肌/巴卡姆坚皮瓣和3例胃上提术）采用局部皮瓣重建，1例患者采用游离空肠瓣重建。2例患者需要进行颈动脉重建。5例肿瘤为经典（传统）乳头状癌变体，其余为侵袭性组织学类型（岛状、高细胞、硬化型）。平均肿瘤大小为4.3±1.6 cm。所有肿瘤均有脉管侵犯，12例有阳性淋巴结。同时，7例存在食管/下咽侵犯，2例存在颈动脉血管侵犯。术后有2例死亡，2例吻合口漏经保守治疗。平均总生存期为31±33个月（中位数27.6个月，范围0 - 120个月）。喉切除术是控制部分晚期甲状腺癌病例的一种替代手术方法，可实现良好的局部控制和长期生存。
