Authors: Yasuhiro Ito Akira Miyauchi Minoru Kihara Takuya Higashiyama Kaoru Kobayashi Akihiro Miya
Publish Date: 2013/08/28
Volume: 38, Issue: 3, Pages: 660-666
Abstract
There are some tracheal surgeries for invasive papillary thyroid carcinoma PTC requiring tracheal resection We create an airtight tracheocutaneostomy TCS by suturing the tracheal hole to the skin when window resection of the trachea is required Here we present the outcomes of PTC patients who underwent surgery with airtight TCSWe enrolled 109 patients 18 males and 91 females who underwent initial surgery for PTC and TCS after partial window resection of the trachea between 1987 and 2010 The average patient age was 61 and the average followup was 99 months The TCS was closed using a local skin flap 3–6 months after surgery in 78 patients and it closed spontaneously in 13 patients The TCS of the remaining 18 patients was not closed for various reasons such as a poor general condition permanent bilateral vocal cord paralysis and loss to followupNone of the 109 patients showed any serious complications of TCS Minor wound infection partial skin necrosis granulation and air leakage were observed in 12 11 2 2 7 6 and 4 4 patients respectively Infection was more likely to occur in patients whose cricoid cartilage was resected p = 00456 Although macroscopically curative surgery was performed for all patients 38 patients 35 had a suspiciously positive margin in the resected tracheal mucosa Five marginpositive 13 and five marginnegative 7 patients showed excision site recurrence but the margin status did not directly affect the prognosis External beam radiation therapy EBRT 50–60 Gy was administered to nine patients none of whom showed excision site recurrence although eight were microscopically marginpositive Among various clinicopathological features tumor size 4 cm and age ≥ 60 years were significant p = 00281 and marginal p = 00771 predictors of excision site recurrence on univariate analysis On multivariate analysis age ≥ 60 years p = 00484 and tumor size 4 cm p = 00763 were independent and marginal predictors of excision site recurrence respectively To date 14 and 17 patients have shown lymph node and distant recurrence respectively and nine have died of PTCTracheocutaneostomy is a safe surgical technique after partial window resection of the trachea although we have to be careful of infection when resecting the cricoid cartilage Large tumor size and old age are risk factors for excision site recurrence EBRT may be useful to prevent excision site recurrence especially in patients with a suspected positive margin
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