Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe 650-0017, Japan.
Endocr J. 2020 Sep 28;67(9):949-956. doi: 10.1507/endocrj.EJ20-0152. Epub 2020 May 27.
To clarify the patterns of the recurrence and to assess the oncological and functional outcomes after salvage surgery for the patients with structural local recurrence of papillary thyroid cancer (PTC), twenty-five patients who underwent salvage surgery for structural local recurrence of PTC were retrospectively reviewed. Structural recurrences were observed in the tracheal lumen in 5 patients, intraluminal or intramuscular esophagus in 5 patients, trachea, and cricoid cartilage in 9 patients, cricoid and thyroid cartilage in 2 patients, intra-lumen of the larynx in 1 patient and soft tissue around thyroid in 3 patients, respectively. Although all local disease was resected with macroscopically negative margin, 10 patients diagnosed as microscopically positive margin. Major surgical complications occurred in 6 patients, including common carotid artery injury (n = 1), unintentional pharyngeal or esophageal injury (n = 2), recurrent laryngeal nerve paralysis (n = 2), and pharyngeal fistula resulting in common carotid artery rupture (n = 1), and were successfully managed. During the follow-up periods, 6 patients were alive without disease, 15 patients survived with distant metastases and/or locoregional recurrence, and 4 patients died of the disease. While tracheocutaneous fistula remained in 7 patients, the vocal function was preserved in all patients but one who underwent total laryngectomy. Normal oral intake was retained in all patients. In conclusion, although salvage surgery for structural recurrence of PTC has a high risk of complications, it may be worthwhile when macroscopic curative resection is available. The decision should be made considering various factors including curability, risk of surgical procedure, functional outcome, and life expectancy.
为了明确局部结构复发的模式，并评估甲状腺乳头状癌（PTC）结构局部复发患者行挽救性手术后的肿瘤学和功能结局，我们回顾性分析了 25 例行挽救性手术治疗 PTC 结构局部复发的患者。5 例患者的结构复发发生在气管腔内，5 例患者的结构复发发生在食管腔内或食管肌层，9 例患者的结构复发发生在气管和环状软骨，2 例患者的结构复发发生在环状软骨和甲状腺软骨，1 例患者的结构复发发生在喉内腔，3 例患者的结构复发发生在甲状腺周围软组织。尽管所有局部疾病均被肉眼阴性切缘切除，但仍有 10 例患者被诊断为镜下阳性切缘。6 例患者发生重大手术并发症，包括颈总动脉损伤（n = 1）、意外的咽或食管损伤（n = 2）、喉返神经麻痹（n = 2）和咽瘘导致颈总动脉破裂（n = 1），均得到成功处理。在随访期间，6 例患者无病生存，15 例患者存活但发生远处转移和/或局部区域复发，4 例患者死于疾病。虽然 7 例患者仍存在气管-皮肤瘘，但所有患者（除 1 例接受全喉切除术的患者外）的声带功能得以保留，所有患者均能正常经口进食。总之，虽然 PTC 结构复发的挽救性手术存在较高的并发症风险，但在能够进行肉眼根治性切除时，可能是值得的。应考虑各种因素，包括可治愈性、手术风险、功能结局和预期寿命，来做出决策。
