Cáncer de tiroides

Surgical management of locally advanced thyroid cancer
Soo-Youn An and Kwang Hyun Kim
Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea Correspondence to Kwang Hyun Kim, MD, PhD, Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, 28 Yongon-Dong, Chongno-Gu, Seoul 110-799, Korea Tel: +822 2072 2286; fax: +82 2 745 2387; e-mail: kimkwang@snu.ac.kr Current Opinion in Otolaryngology & Head and Neck Surgery 2010, 18:119–123

Purpose of review To summarize recent literature with respect to locally invasive thyroid cancer and discuss the variety of surgical management techniques according to the sites involved. Recent findings Different philosophies for surgical strategy in patientswith locally invasive thyroid cancer still exist. Intraoperative neuromonitoring assessment of the functional status of the recurrent laryngeal nerve is helpful to decide surgical extent. A staging system based on the degree of invasion has been suggested for the proper management of laryngotracheal invasion. Summary The goal of treatment of locally invasive thyroid cancer is to maximize localcontrol and overall survival while minimizing the morbidity of a radical resection or preserving function of adjacent vital structures with conservative procedures. It is imperative that the operating surgeon be familiar with an algorithm for the appropriate workup and surgical planning. In addition, various factors such as the patient’s age, tumor biology and histopathology, previous response totreatment, presence of distant metastasis, or adjuvant therapy can affect the extent of surgical resection. Keywords locally invasive, surgery, thyroid cancer
Curr Opin Otolaryngol Head Neck Surg 18:119–123 ß 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 1068-9508

Introduction
The majority of patients with thyroid carcinoma have tumors with well differentiated histology, with anexcellent overall prognosis. However, 6–13% of these tumors can display extrathyroidal extension, which is associated with an increased incidence of local recurrence, and regional and distant metastasis, and decreased survival [1,2]. The most commonly involved structures with invasive thyroid cancer are strap muscles (53%), recurrent laryngeal nerve (RLN) (47%), trachea (37%), esophagus (21%), larynx(12%), and other sites (30%) [3]. Although the invasion of extrathyroidal structures most frequently occurs by primary tumor, it may also occur from extranodal extension of metastatic disease [4]. Surgical resection still remains the mainstay of treatment for locally invasive thyroid cancer; however, the extent of surgery has been a source of great controversy. Although all agree that completeresection with negative margins is the best treatment option, resection of vital structures such as the RLN, trachea, larynx, and esophagus can be associated with significant morbidity. Some authors have reported that, unless the invasion is deep, there is no significant difference in survival between the patients who were treated with conservative approaches such as resecting or shaving off the grosstumor with subsequent
1068-9508 ß 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

radioactive iodine (RAI) or external beam radiotherapy (EBRT) and those who underwent radical resection [3,5,6]. Other authors have suggested that more aggressive approaches including en bloc resection of the tumor and surrounding involved structures with negative margins could improve the long-termlocal control and survival rates [7–10]. This is a review of the available literature regarding thyroid cancer invasion of central neck structures and a discussion of the appropriate surgical treatment options.

Surgical management of locally invasive thyroid cancer according to involved sites
It is important to plan appropriate surgical management according to the structures involved in...