Management of recurrent laryngeal cancer presents a major challenge, and salvage laryngectomy is complicated by previous oncologic treatments. Thyroidectomy as part of salvage laryngectomy adds a nonnegligible degree of morbidity. The purpose of this study is to assess the rate of thyroid gland invasion in patients undergoing salvage laryngectomy to determine relevant predictive factors.
Study Design
Case series with chart review.
Setting
Department of Otorhinolaryngology, Head and Neck Surgery, Guy’s Hospital, London, United Kingdom.
Methods
A retrospective review of patients undergoing salvage laryngectomy between 2009 and 2019 was undertaken. Preoperative cross-sectional imaging and histopathological analysis were performed to define evidence and predictors of thyroid gland invasion (TGI).
Results
Fifty-one patients had salvage laryngectomy. Histological evidence of TGI was found in 4 patients (7.8%). No significant relationship was found between histological TGI and subsite of primary carcinoma, degree of differentiation, T staging, or radiological TGI. Preoperative computed tomography had a high negative predictive value for TGI.
Conclusion
Thyroidectomy should be carefully considered in patients undergoing salvage laryngectomy, and its extent should be defined on an individual basis. Total thyroidectomy should not routinely be performed in salvage laryngectomy or pharyngolaryngectomy in patients with no preoperative radiological evidence of TGI on cross-sectional imaging, unless there is intraoperative evidence of TGI.
HayASimoRHallG, et al. Outcomes of salvage surgery for the oropharynx and larynx: a contemporary experience in a UK Cancer Centre. Eur Arch Otorhinolaryngol. 2019;276(4):1153-1159.
2.
MimicaXHansonMPatelSG, et al. Salvage surgery for recurrent larynx cancer. Head Neck. 2019;41(11):3906-3915.
3.
TanHKGigerRAuperinABourhisJJanotFTemamS.Salvage surgery after concomitant chemoradiation in head and neck squamous cell carcinomas—stratification for postsalvage survival. Head Neck. 2010;32(2):139-147.
4.
HamoirMHolvoetEAmbroiseJLengeléBSchmitzS.Salvage surgery in recurrent head and neck squamous cell carcinoma: oncologic outcome and predictors of disease free survival. Oral Oncol. 2017;67:1-9.
5.
SimoRRoviraATownleyW.Salvage treatment options after failed primary treatment of hypopharyngeal cancer. Adv Otorhinolaryngol. 2019;83:135-147.
6.
PangLJeannonJPSimoR.Minimizing complications in salvage head and neck oncological surgery following radiotherapy and chemo-radiotherapy. Curr Opin Otolaryngol Head Neck Surg. 2011;19(2):125-131.
7.
SimoRBradleyPChevalierD, et al. European Laryngological Society: ELS recommendations for the follow-up of patients treated for laryngeal cancer. Eur Arch Otorhinolaryngol. 2014;271(9):2469-2479.
8.
Al-HakamiHAAl GarniMAAlSubayeaH, et al. The incidence of thyroid gland invasion in advanced laryngeal squamous cell carcinoma [published December9, 2019]. Braz J Otorhinolaryngol.
9.
McGuireJKViljoenGRockeJFitzpatrickSDalvieSFaganJJ.Does thyroid gland preserving total laryngectomy affect oncological control in laryngeal carcinoma [published August8, 2019]? Laryngoscope.
10.
IypeEMJagadVKumarNSVargheseBTSebastianP.Thyroid gland involvement in carcinoma larynx and hypopharynx-predictive factors and prognostic significance. J Clin Diagnostic Res. 2016;10(2):XC05-XC07.
11.
ElliottMSOdellEWTysomeJR, et al. Role of thyroidectomy in advanced laryngeal and pharyngolaryngeal carcinoma. Otolaryngol Head Neck Surg. 2010;142(6):851-855.
12.
LiSXPolaccoMAGosselinBJHarringtonLXTitusAJPaydarfarJA.Management of the thyroid gland during laryngectomy. J Laryngol Otol. 2017;131(8):740-744.
13.
GoodwinWJ.Salvage surgery for patients with recurrent squamous cell carcinoma of the upper aerodigestive tract: when do the ends justify the means?Laryngoscope. 2000;110(3, pt 2)(suppl 93):1-18.
14.
BirkelandACBeesleyLBellileE, et al. Predictors of survival after total laryngectomy for recurrent/persistent laryngeal squamous cell carcinoma. Head Neck. 2017;39(12):2512-2518.
15.
BossiPAlfieriSStrojanP, et al. Prognostic and predictive factors in recurrent and/or metastatic head and neck squamous cell carcinoma: a review of the literature. Crit Rev Oncol Hematol. 2019;137:84-91.
16.
GilbertRWCullenRJVan NostrandAWPBryceDPHarwoodAR.Prognostic significance of thyroid gland involvement in laryngeal carcinoma. Arch Otolaryngol Neck Surg. 1986;112(8):856-859.
17.
BrennanJAMeyersADJafekBW.The intraoperative management of the thyroid gland during laryngectomy. Laryngoscope. 1991;101(9):929-934.
18.
DadasBUsluBÇakirBÖzdoǧanHCÇalişABTurgutS.Intraoperative management of the thyroid gland in laryngeal cancer surgery. J Otolaryngol. 2001;30(3):179-183.
19.
SparanoAChernockRLaccourreyeOWeinsteinGFeldmanM.Predictors of thyroid gland invasion in glottic squamous cell carcinoma. Laryngoscope. 2005;115(7):1247-1250.
20.
MendelsonAAAl-KhatibTAJulienMPayneRJBlackMJHierMP.Thyroid gland management in total laryngectomy: meta-analysis and surgical recommendations. Otolaryngol Head Neck Surg. 2009;140(3):298-305.
21.
BielMAMaiselRH.Indications for performing hemithyroidectomy for tumors requiring total laryngectomy. Am J Surg. 1985;150(4):435-439.
VermundHKrajciPEideTJWintherF.Laryngectomy whole organ serial sections: histological parameters correlated with recurrence rate. Acta Oncol (Madr). 2004;43(1):98-107.
24.
Gallegos-HernándezJFMinauro-MuñozGHernández-HernándezDMFlores-CarranzaAHernández-SanjuánMReséndiz-ColosiaJA.Thyroidectomy associated with laryngectomy in laryngeal cancer treatment: is it routinely necessary?Cir Cir. 2005;73(1):3-6.
25.
MillerMCAgrawalA.Hypothyroidism in postradiation head and neck cancer patients: incidence, complications, and management. Curr Opin Otolaryngol Head Neck Surg. 2009;17(2):111-115.
26.
RoskoAJBirkelandACBellileE, et al. Hypothyroidism and wound healing after salvage laryngectomy. Ann Surg Oncol. 2018;25(5):1288-1295.
27.
TurnerSLTiverKWBoyagesSC. Thyroid dysfunction following radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys. 1995;31(2):279-283.
28.
SinardRJTobinEJMazzaferriEL, et al. Hypothyroidism after treatment for nonthyroid head and neck cancer. Arch Otolaryngol Head Neck Surg. 2000;126(5):652-657.
29.
ThorpMALevittNSMortimoreSIsaacsS.Parathyroid and thyroid function five years after treatment of laryngeal and hypopharyngeal carcinoma. Clin Otolaryngol Allied Sci. 1999;24(2):104-108.
30.
Lo GalboAMKuikDJLipsP, et al. A prospective longitudinal study on endocrine dysfunction following treatment of laryngeal or hypopharyngeal carcinoma. Oral Oncol. 2013;49(9):950-955.
31.
KojimaRTsukaharaKMotohashiR, et al. Extent of thyroid resection and thyroid function after postoperative radiotherapy following total laryngectomy or total pharyngo-laryngo-esophagectomy. Int J Clin Oncol. 2017;22(3):438-441.
32.
MulhollandGBZhangHNguyenNA, et al. Optimal detection of hypothyroidism in early stage laryngeal cancer treated with radiotherapy. J Otolaryngol Head Neck Surg. 2015;44(34):1-7.
33.
KumarSMoorthyRDhanasekarGThompsonSGriffithsH.The incidence of thyroid dysfunction following radiotherapy for early stage carcinoma of the larynx. Eur Arch Otorhinolaryngol. 2011;268(10):1519-1522.
34.
KumpulainenEJHirvikoskiPPVirtaniemiJA, et al. Hypothyroidism after radiotherapy for laryngeal cancer. Radiother Oncol. 2000;57:97-100.
35.
Lo GalboAMDe BreeRKuikDJ, et al. The prevalence of hypothyroidism after treatment for laryngeal and hypopharyngeal carcinomas: are autoantibodies of influence?Acta Otolaryngol. 2007;127(3):312-317.
36.
LeónXGrasJRPérezA, et al. Hypothyroidism in patients treated with total laryngectomy: a multivariate study. Eur Arch Otorhinolaryngol. 2002;259(4):193-196.
37.
HamoirMSchmitzSSuarezC, et al. The current role of salvage surgery in recurrent head and neck squamous cell carcinoma. Cancers (Basel). 2018;10(8):267.
38.
Lo GalboAMDe BreeRKuikDJLipsPLeemansCR.Paratracheal lymph node dissection does not negatively affect thyroid dysfunction in patients undergoing laryngectomy. Eur Arch Otorhinolaryngol. 2010;267(5):807-810.
39.
BasheethNO’CathainEO’LearyGSheahanP.Hypocalcemia after total laryngectomy: incidence and risk factors. Laryngoscope. 2014;124(5):1128-1133.
40.
AlmquistMIvarssonKNordenströmEBergenfelzA.Mortality in patients with permanent hypoparathyroidism after total thyroidectomy. Br J Surg. 2018;105(10):1313-1318.
41.
KumarRDrinnanMRobinsonM, et al. Thyroid gland invasion in total laryngectomy and total laryngopharyngectomy: a systematic review and meta-analysis of the English literature. Clin Otolaryngol. 2013;38(5):372-378.
42.
PezierTFNixonIJJoshiA, et al. Pre-operative tracheostomy does not impact on stomal recurrence and overall survival in patients undergoing primary laryngectomy. Eur Arch Otorhinolaryngol. 2013;270(5):1729-1735.
