Ballantyne A J
Department of Head and Neck Surgery, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Am J Surg. 1994 Dec;168(6):636-9. doi: 10.1016/s0002-9610(05)80136-9.
In view of the indolent nature of most cancers of the thyroid, particularly of the papillary and follicular variety, the decision to remove a segment of the upper aerodigestive tract when the cancer is either close to or invading this area is a difficult one. It was felt relevant to review the experience at the M.D. Anderson Hospital to see when such resections were necessary, how they were repaired, and the survival rates.
Of the 1,098 patients with cancers of the thyroid treated surgically at M.D. Anderson Cancer Center from 1954 to 1993, 46 underwent resections of some portion of the upper aerodigestive tract for invasive cancer. These included 35 patients who had histories of prior surgical treatment with or without radiation or radioactive iodine therapy. The operations included 27 total and 5 partial laryngectomies, 1 circumferential and 13 partial resections of the trachea, and 5 circumferential and 10 partial esophagectomies. Several patients had combinations of these procedures. Details of the repairs are provided. Postoperative radiation or radioactive iodine treatment was administered when indicated.
Local recurrence was infrequent. Most deaths occurred from either pulmonary metastasis or causes other than the cancer. The 5-year survival rate for all patients exceeded 50%. More than 70% of patients with papillary and follicular cancers survived for 5 years, and some for up to 30 years.
Although it cannot be stated with any degree of certainty if a resection of a portion of the upper aerodigestive tract should be done at the time of the initial surgical procedure, it is apparent that there are some situations in which the resection should be done because of severe local problems A variety of methods of repair are available, and the survival rate is greater than 50% for all such procedures, with those having the papillary and follicular variety surviving for 5 years in more than 70% of cases. Patients can exist with severe local problems for a number of years and it is sometimes the patient who decides when the resection should be done.
鉴于大多数甲状腺癌，尤其是乳头状癌和滤泡状癌生长缓慢的特性，当癌症接近或侵犯上呼吸道消化道区域时，决定是否切除该区域的一部分是一项艰难的抉择。回顾MD安德森癌症中心的经验，以了解何时需要进行此类切除手术、如何进行修复以及生存率情况，被认为是有必要的。
1954年至1993年在MD安德森癌症中心接受手术治疗的1098例甲状腺癌患者中，46例因浸润性癌症接受了上呼吸道消化道部分切除术。其中包括35例曾接受过手术治疗，有或没有接受过放疗或放射性碘治疗的患者。手术包括27例全喉切除术和5例部分喉切除术、1例气管环形切除术和13例气管部分切除术，以及5例食管环形切除术和10例食管部分切除术。部分患者接受了多种手术联合治疗。文中提供了修复细节。术后根据指征进行放疗或放射性碘治疗。
局部复发并不常见。大多数死亡是由肺转移或癌症以外的原因导致的。所有患者的5年生存率超过50%。超过70%的乳头状癌和滤泡状癌患者存活了5年，有些患者存活了长达30年。
虽然无法确切说明在初次手术时是否应该切除上呼吸道消化道的一部分，但显然在某些情况下，由于严重的局部问题，应该进行切除手术。有多种修复方法可用，所有此类手术的生存率均大于50%，乳头状癌和滤泡状癌患者5年生存率超过70%。患者可以在存在严重局部问题的情况下存活数年，有时是由患者决定何时进行切除手术。
