Aggressive surgical approach for locally invasive papillary carcinoma of the thyroid in patients over forty-five years of age.

Aggressive radical resection was performed on 18 of 21 elderly patients with locally invasive-papillary carcinoma of the thyroid. Diagnostic studies, including computed tomographic and endoscopic examinations, were useful in allowing accurate determination of tumor extent. Radical resection usually consisted of total or subtotal thyroidectomy and neck dissection combined with excision of the affected organs, which in one case included a laryngotracheoesophagectomy (reconstruction of the digestive tract with a forearm free flap), a sleeve, or a window resection of the trachea in nine cases (immediate end-to-end anastomosis in all but one), a partial esophagectomy in two cases, and resection of the outer layer of the trachea or esophagus in six cases. After these operations, one patient died of rupture of the carotid artery, one died of cancer in 4 years, and one other died of unrelated disease. The other 15 patients are alive and well 1 to 5 years postoperatively, although additional exploration for nodal metastases was required in three patients. Aggressive resection therefore appears to be justified for control of locally advanced, differentiated carcinoma of the thyroid.