Annals of Surgical Oncology

, Volume 22, Issue 12, pp 4002–4007 | Cite as

Surgical Management of Cricotracheal Invasion by Papillary Thyroid Carcinoma

  • Sueyoshi MoritaniEmail author
Head and Neck Oncology



In general, patients with papillary thyroid carcinoma (PTC) have an excellent postoperative prognosis. Those with cricoid and/or tracheal PTC invasion, however, are at a higher risk of postoperative morbidity and airway insufficiency.


We investigated postoperative airway outcomes, locoregional recurrence, and survival rates in patients with PTC who underwent cricotracheal resection. The records of PTC patients who underwent surgery at our institution between 1981 and 2009 were reviewed retrospectively, and 110 patients with cricotracheal invasion were enrolled. Curative resection was performed in all patients, and cricotracheal function was preserved or reconstructed when possible.


Of the 110 patients, 57 and 53 patients had superficial and intraluminal invasion of the larynx, respectively. After the initial surgery, the 10-year disease-specific survival rates were 90.8 and 44.4 % in patients with superficial and intraluminal invasion of the cricotracheal area, respectively. Only six patients (5.5 %) had an isolated upper aerodigestive tract recurrence. Five patients were managed with an additional window resection as salvage surgery. Consequently, only one patient (0.9 %) underwent total laryngectomy. Altogether, 31 patients (28.0 %) had a permanent stoma, 9 and 15 of which were caused by cricotracheal invasion and invasion of other aerodigestive structures, respectively.


Window resection for intraluminal cricotracheal invasion by PTC produced good surgical outcomes that resulted in a low local recurrence rate and survival rates that resembled those associated with other surgical treatments. Treatment of multiple organ invasion of the aerodigestive tract was necessary to improve postoperative functional outcomes in these patients.


Papillary Thyroid Carcinoma Recurrent Laryngeal Nerve Aerodigestive Tract Total Laryngectomy Papillary Thyroid Carcinoma Patient 
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  1. 1.
    Park CS, Suh KW, Min JS. Cartilage-shaving procedure for the control of tracheal cartilage invasion by thyroid carcinoma. Head Neck. 1993;15:289–91.CrossRefPubMedGoogle Scholar
  2. 2.
    Nishida T, Nakao K, Hamaji M. Differentiated thyroid carcinoma with airway invasion: indication for tracheal resection based on the extent of cancer invasion. J Thorac Cardiovasc Surg. 1997;114:84–92.CrossRefPubMedGoogle Scholar
  3. 3.
    Honings J, Stephen AE, Marres HA, Gasser HA. The management of thyroid carcinoma invading the larynx or trachea. Laryngoscope. 2010;120:682–9.CrossRefPubMedGoogle Scholar
  4. 4.
    McCaffrey TV, Bergstralh EJ, Hay ID. Locally invasive papillary thyroid carcinoma: 1940–1990. Head Neck. 1994;16:165–72.CrossRefPubMedGoogle Scholar
  5. 5.
    McCaffrey JC. Aerodigestive tract invasion by well-differentiated thyroid carcinoma: diagnosis, management, prognosis, and biology. Laryngoscope. 2006;116:1–11.CrossRefPubMedGoogle Scholar
  6. 6.
    Hotomi M, Sugitani I, Toda K, Kawabata K, Fujimoto Y. A novel definition of extrathyroidal invasion for patients with papillary thyroid carcinoma for predicting prognosis. World J Surg. 2012;36:1231–40.CrossRefPubMedGoogle Scholar
  7. 7.
    Wada N, Nakayama H, Masudo Y, Suganuma N, Rino Y. Clinical outcome of different modes of resection in papillary thyroid carcinomas with laryngotracheal invasion. Langenbecks Arch Surg. 2006;391:545–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Bayles SW, Kingdom TT, Carlson GW. Management of thyroid carcinoma invading the aerodigestive tract. Laryngoscope. 1998;108:1402–7.CrossRefPubMedGoogle Scholar
  9. 9.
    Czaja JM, McCaffrey TV. The surgical management of laryngotracheal invasion by well–differentiated papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg. 1997;123:484–90.CrossRefPubMedGoogle Scholar
  10. 10.
    Kowalski LP, Filho JG. Results of the treatment of locally invasive thyroid carcinoma. Head Neck. 2002;24:340–4.CrossRefPubMedGoogle Scholar
  11. 11.
    Tsukahara K, Sugitani I, Kawabata K. Surgical management of tracheal shaving for papillary thyroid carcinoma with tracheal invasion. Acta Otolaryngol. 2009;129:1498–502.CrossRefPubMedGoogle Scholar
  12. 12.
    Ito Y, Fukushima M, Yabuta T, et al. Local prognosis of patients with papillary thyroid carcinoma who were intra-operatively diagnosed as having minimal invasion of the trachea: a 17-year experience in a single institute. Asian J Surg. 2009;32:102–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Tsai YF, Tseng YL, Wu MH, Hung CJ, Lai WW, Lin MY. Aggressive resection of the airway invaded by thyroid carcinoma. Br J Surg. 2005;92:1382–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Ozaki O, Sugino K, Mimura T, Ito K. Surgery for patients with thyroid carcinoma invading the trachea: circumferential sleeve resection followed by end-to-end anastomosis. Surgery. 1995;117:268–71.CrossRefPubMedGoogle Scholar
  15. 15.
    McCarty TM, Kuhn JA, Williams WL Jr, et al. Surgical management of thyroid cancer invading the airway. Ann Surg Oncol. 1997;4:403–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Gaissert HA, Honings J, Grillo HC, et al. Segmental laryngotracheal and tracheal resection for invasive thyroid carcinoma. Ann Thorac Surg. 2007;83:1952–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Nakao K, Kurozumi K, Nakahara M, Kido T. Resection and reconstruction of the airway in patients with advanced thyroid cancer. World J Surg. 2004;28:1204–6.CrossRefPubMedGoogle Scholar

Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  1. 1.Center for Head and Neck Surgery, Kusatsu General HospitalKusatsuJapan

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