Abstract
Background
Widely invasive extrathyroidal thyroid cancer invading the aerodigestive tract (ADT) including larynx, trachea, hypopharynx, and/or esophagus occurs in 1–8 % of patients with thyroid cancer and is classified as T4a (current UICC/AJCC system). The T4a stage is associated with impaired tumor-free survival and increased disease-specific mortality. Concerning prognosis and outcome, further subdivisions of the T4a stage, however, have not been made so far.
Methods
This study is based on a systematic review of the relevant literature in the PubMed database.
Results
Retrospective studies suggest a better outcome in patients with invasion of the trachea or the esophagus when compared to laryngeal invasion. Regarding surgical strategies, ADT invasion can be classified based on a three-dimensional assessment determining surgical resection options. Regardless of the invaded structure, tumor infiltration of the ADT can be subdivided into superficial, deep extraluminal, and intraluminal invasion. In contrast to superficial ADT invasion, allowing tangential incomplete wall resection (shaving/extramucosal esophagus resection), deeper wall and intraluminal invasions require complete wall resection (either window or sleeve). Based on the Dralle classification (types 1–6), particularly airway invasion, can be further classified according to the vertical and horizontal extents of tumor invasion.
Conclusions
The Dralle classification can be considered as a reliable subdivision system evaluated regarding surgical options as well as oncological outcome. However, further studies determining the prognostic impact of this technically oriented classification system are required.
Similar content being viewed by others
References
Sobin LH, Gospodarowicz MK, Wittekind C (eds) (2009) TNM classification of malignant tumors (UICC International Union Against Cancer), 7th edn. Wiley-Blackwell, Oxford
Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A (eds) (2010) AJCC cancer staging manual, 7th edn. Springer, New York
Shaha AR (2009) TNM classification of thyroid carcinoma. Thyroid 19:1167–1214
Cooper DS, Doherty GM, Haugen BR et al (2009) Revised American Thyroid Association management guidelines for patients with thyroid nodules and differentiated thyroid cancer. Thyroid 19:1167–1214
Dralle H, Brauckhoff M, Machens A, Gimm O (2005) Surgical management of advanced thyroid cancer invading the aerodigestive tract. In: Clark OH, Duh QY, Kebebew E (eds) Textbook on endocrine surgery, 2nd edn. Elsevier Saunders, Philadelphia, pp page 318–page 333
Brauckhoff M, Dralle H (2011) Extrathyroidal thyroid cancer: results of tracheal shaving and tracheal resection. Chirurg 82:134–140
Brauckhoff M, Dralle H (2009) Cervicovisceral resection in invasive thyroid tumors. Chirurg 80:88–98
Wu HS, Young MT, Ituarte PH et al (2000) Death from thyroid cancer of follicular cell origin. J Am Coll Surg 191:600–606
Brauckhoff M, Machens A, Thanh PN et al (2010) Impact of extent of resection for thyroid cancer invading the aerodigestive tract on surgical morbidity, local recurrence, and cancer-specific survival. Surgery 148:1257–1266
Honings J, Stephen AE, Marres HA, Gaissert HA (2010) The management of thyroid carcinoma invading the larynx or trachea. Laryngoscope 120:682–689
Gaissert HA, Honings J, Grillo HC et al (2007) Segmental laryngotracheal and tracheal resection for invasive thyroid carcinoma. Ann Thorac Surg 83:1952–1959
Shin DH, Mark EJ, Suen HC, Grillo HC (1993) Pathologic staging of papillary carcinoma of the thyroid with airway invasion based on the anatomic manner of extension to the trachea: a clinicopathologic study based on 22 patients who underwent thyroidectomy and airway resection. Hum Pathol 24:866–870
Scheumman GF, Hoang-Vu C, Cetin Y et al (1995) Clinical significance of E-cadherin as a prognostic marker in thyroid carcinomas. J Clin Endocrinol Metab 80:2168–2172
Buergy D, Weber T, Maurer GD et al (2009) Urokinase receptor, MMP-1 and MMP-9 are markers to differentiate prognosis, adenoma and carcinoma in thyroid malignancies. Int J Cancer 125:894–901
Czaja JM, McCaffrey TV (1997) The surgical management of laryngotracheal invasion by well-differentiated papillary thyroid carcinoma. Arch Otolaryngol Head Neck Surg 123:484–490
Shimamoto K, Satake H, Sawaki A et al (1998) Preoperative staging of thyroid papillary carcinoma with ultrasonography. Eur J Radiol 29:4–10
Tomoda C, Uruno T, Takamura Y et al (2005) Ultrasonography as a method of screening for tracheal invasion by papillary thyroid cancer. Surg Today 35:819–822
Yamamura N, Fukushima S, Nakao K et al (2002) Relation between ultrasonographic and histologic findings of tracheal invasion by differentiated thyroid cancer. World J Surg 26:1071–1073
Wakamatsu T, Tsushima K, Yasuo M et al (2006) Usefulness of preoperative endobronchial ultrasound for airway invasion around the trachea: esophageal cancer and thyroid cancer. Respiration 73:651–657
Wang JC, Takashima S, Takayama F et al (2001) Tracheal invasion by thyroid carcinoma: prediction using MR imaging. Am J Roentgenol 177:929–936
Brauckhoff M, Meinicke A, Bilkenroth U et al (2006) Long-term results and functional outcome after cervical evisceration in patients with thyroid cancer. Surgery 140:953–959
Grillo HC, Suen HC, Mathisen DJ, Wain JC (1992) Resectional management of thyroid carcinoma invading the airway. Ann Thorac Surg 54:3–10
Dralle H, Scheumann GFW. (1993) Cervicovisceral reconstruction after resection of locally advanced thyroid carcinoma. Langenbecks Arch Chir (Suppl) pp. 486-489
Musholt TJ, Musholt PB, Behrend M et al (1999) Invasive differentiated thyroid carcinoma: tracheal resection and reconstruction procedures in the hands of the endocrine surgeon. Surgery 126:1078–1087
Lipton RJ, McCaffrey T, van Heerden J (1987) Surgical treatment of invasion of the upper aerodigestive tract by well-differentiated thyroid carcinoma. Am J Surg 154:363–367
McCaffrey TV, Bergstralh EJ, Hay ID (1994) Locally invasive papillary thyroid carcinoma: 1940–1990. Head Neck 16:165–172
McCarty TM, Kuhn JA, Williams WL Jr et al (1997) Surgical management of thyroid cancer invading the airway. Ann Surg Oncol 4:403–408
Melliere DJ, Ben Yahia NE, Becquemin JP et al (1993) Thyroid carcinoma with tracheal or esophageal involvement: limited or maximal surgery? Surgery 113:166–172
Friedmann M, Danielzadeh JA, Caldarelli DD (1994) Treatment of patients with carcinoma of the thyroid invading the airway. Arch Otolaryngol Head Neck Surg 120:1377–1381
Nishida T, Nakao K, Hamaji M (1997) Differentiated thyroid carcinoma with airway invasion: indication for tracheal resection based on the extent of cancer invasion. J Thorac Cardiovasc Surg 114:84–92
Segal K, Shpitzer T, Hazan A et al (2006) Invasive well-differentiated thyroid carcinoma: effect of treatment modalities on outcome. Otolaryngol Head Neck Surg 134:819–822
Tsai YF, Tseng YL, Wu MH et al (2005) Aggressive resection of the airway invaded by thyroid carcinoma. Br J Surg 92:1382–1387
Wada N, Nakayama H, Masudo Y et al (2006) Clinical outcome of different modes of resection in papillary thyroid carcinomas with laryngotracheal invasion. Langenbecks Arch Surg 391:545–549
Xu XF, Li ZJ, Wang X, Tang PZ (2004) The management and prognosis of laryngotracheal invasion by well-differentiated thyroid carcinoma. Zhonghua Yi Xue Za Zhi 84:1888–1891
Conflicts of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Brauckhoff, M. Classification of aerodigestive tract invasion from thyroid cancer. Langenbecks Arch Surg 399, 209–216 (2014). https://doi.org/10.1007/s00423-013-1142-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00423-013-1142-x