Matsumoto Fumihiko, Ikeda Katsuhisa
Department of Otorhinolaryngology, Juntendo University Faculty of Medicine, Tokyo 113-8431, Japan.
Cancers (Basel). 2021 Feb 14;13(4):797. doi: 10.3390/cancers13040797.
Well-differentiated thyroid carcinoma (WDTC) is a slow-growing cancer with a good prognosis, but may show extraglandular progression involving the invasion of tumor-adjacent tissues, such as the trachea, esophagus, and recurrent laryngeal nerve. Tracheal invasion by WDTC is infrequent. Since this condition is rare, relevant high-level evidence about it is lacking. Tracheal invasion by a WDTC has a negative impact on survival, with intraluminal tumor development constituting a worse prognostic factor than superficial tracheal invasion. In WDTC, curative resection is often feasible with a small safety margin, and complete resection can ensure a good prognosis. Despite its resectability, accurate knowledge of the tracheal and peritracheal anatomy and proper selection of surgical techniques are essential for complete resection. However, there is no standard guideline on surgical indications and the recommended procedure in trachea-invading WDTC. This review discusses the indications for radical resection and the three currently available major resection methods: shaving, window resection, and sleeve resection with end-to-end anastomosis. The review shows that the decision for radical resection should be based on the patient's general condition, tumor status, expected survival duration, and the treating facility's strengths and weaknesses.
高分化甲状腺癌（WDTC）是一种生长缓慢、预后良好的癌症，但可能出现腺外进展，累及肿瘤相邻组织，如气管、食管和喉返神经。WDTC侵犯气管的情况并不常见。由于这种情况罕见，缺乏相关的高级别证据。WDTC侵犯气管对生存有负面影响，腔内肿瘤发展是比气管浅表侵犯更差的预后因素。在WDTC中，通常可行小安全切缘的根治性切除，完整切除可确保良好预后。尽管其可切除性，但准确了解气管和气管周围解剖结构以及正确选择手术技术对于完整切除至关重要。然而，对于侵犯气管的WDTC，目前尚无关于手术指征和推荐手术方法的标准指南。本综述讨论了根治性切除的指征以及目前可用的三种主要切除方法：刮除术、开窗切除术和端端吻合的袖状切除术。综述表明，根治性切除的决定应基于患者的一般状况、肿瘤状态、预期生存时间以及治疗机构的优缺点。
