Lokalrezidive von jodrefraktären Schilddrüsenkarzinomen – chirurgische Therapieoption bei Infiltration des Kehlkopfs

Zusammenfassung

Ziel Lokalrezidive von Schilddrüsenkarzinomen können zu einer Tumorinfiltration im unteren Kehlkopfbereich führen. Da diese Tumoren in der Regel nicht mehr jodspeichernd sind, sind die weiteren Therapieoptionen erheblich eingeschränkt. Die vorliegende Arbeit beschreibt unsere Erfahrung mit laryngotrachealen Resektionen dieser Lokalrezidive.

Material und Methode Von Juli 2019 bis November 2020 behandelten wir 5 Patienten mit maligner Infiltration der Trachea und des Larynx durch ein Lokalrezidiv eines Schilddrüsenkarzinoms. Wir führten bei 4 Patienten eine laryngotracheale Resektion mit End-zu-End-Anastomose durch, bei einer Patientin erfolgte eine frontolaterale Teillaryngektomie.

Ergebnisse Der Krankenhausaufenthalt betrug median 6 Tage (5–14). Eine R0-Resektion wurde nur bei 2 Patienten erreicht. Bei keinem Patienten traten Probleme mit der Anastomose oder eine beidseitige Rekurrensparese auf. Ein Patient musste am ersten postoperativen Tag wegen zunehmenden Lungenversagens reintubiert werden. Er konnte nach 5 Tagen extubiert werden.

Schlussfolgerung Hohe Trachealresektionen mit Teilresektion des Larynx können mit geringem Risiko durchgeführt werden. Obwohl onkologisch radikale Resektionen selten sind, stellen diese Resektionen eine Erweiterung der Therapieoptionen bei jodrefraktären Lokalrezidiven von Schilddrüsenkarzinomen dar. Hohe Trachealresektionen könnten Teil des onkologischen Therapiespektrums beim lokal rezidivierenden, nicht mehr Jod speichernden Schilddrüsenkarzinom werden.

Abstract

Aim Local recurrence of thyroid carcinomas can result in tumor infiltration in the lower region of the larynx. Since these tumors typically no longer store iodine, treatment options are greatly limited. The present study describes our experience with laryngo-tracheal resection of such cases of local recurrence.

Materials and Methods From July 2019 to November 2020, we treated five patients with malignant infiltration of the trachea and larynx due to local recurrence of a thyroid carcinoma. We performed laryngo-tracheal resection with end-to-end anastomosis in four patients and frontolateral partial laryngectomy in one patient.

Results The median length of hospital stay was 6 days (5–14). An R0 resection was performed in two patients. Problems with the anastomosis or bilateral recurrent laryngeal nerve paralysis was not seen in any of the patients. One patient had to be reintubated on the second postoperative day due to lung failure. He was able to be extubated after five days.

Conclusion High tracheal resection with partial resection of the larynx was able to be performed with minimal risk. Although radical resections are rare, they expand oncological treatment options in the case of local recurrence of thyroid carcinomas that are iodine-refractory. High tracheal resection could be part of the oncological treatment spectrum in the case of local recurrence of thyroid carcinomas that no longer store iodine.

Schlüsselwörter

Lokalrezidiv Schilddrüsenkarzinom - maligne Trachealinfiltration - onkologische Tracheaquerresektion - N. laryngeus recurrens - FDG-PET/CT - Radiojodtherapie

Key words

local recurrence of thyroid carcinoma - malignant infiltration of the trachea - oncological cross-section of the trachea - recurrent laryngeal nerve - FDG PET/CT - radioiodine therapy

Publication History

Received: 26 March 2021

Accepted: 18 April 2021

Article published online:
25 May 2021

• Literatur

• 1 Adam MA, Pura J, Goffredo P. et al. Presence and number of lymph node metastases are associated with compromised survival for patients younger than age 45 years with papillary thyroid cancer. J Clin Oncol 2015; 33: 2370-2375 DOI: 10.1200/JCO.2014.59.8391.
• 2 AWMF-Leitlinie 2012. Operative Therapie maligner Schilddrüsenerkrankungen. AWMF- Register Nr. 088/002, Klasse S2k.
• 3 Brierley JD, Tsang RW. External beam radiation therapy for thyroid cancer. Endocrinol Metabol Clinics North Am 2008; 37: 497-509 DOI: 10.1016/j.ecl.2008.02.001.
• 4 Brown SR, Hall A, Buckley HL. et al. Investigating the potential clinical benefit of Selumetinib in resensitising advanced iodine refractory differentiated thyroid cancer to radioiodine therapy (SEL-I-METRY): protocol for a multicentre UK single arm phase II trial. BMC Cancer 2019; 19: 582 DOI: 10.1186/s12885-019-5541-4.
• 5 Chereau N, Dauzier E, Godiris-Petit G. et al. Risk of Recurrence in a Homogeneously Managed pT3-differentiated Thyroid Carcinoma Population. Langenbecks Arch Surg 2018; 403: 325-332 DOI: 10.1007/s00423-018-1657-2.
• 6 Fürst H, Tsalos N, Fertl A. Modifizierte Resektionstechnik bei idiopathischen subglottischen Trachealstenosen. Z Herz- Thorax- Gefäßchir 2019; 33: 387-392 DOI: 10.1007/s00398-019-0320-8.
• 7 Gaissert HA, Honings J, Grillo HC. et al. Segmental laryngotracheal and tracheal resection for invasive thyroid carcinoma. Ann Thorac Surg 2007; 83: 1952-1959 DOI: 10.1016/j.athoracsur.2007.01.056.
• 8 Grant C. Recurrence of papillary thyroid cancer after optimized surgery. Gland Surg 2015; 4: 52-62 DOI: 10.3978/j.issn.2227-684X.2014.12.06.
• 9 Grillo HC, Suen HC, Mathisen DJ. et al. Resectional management of thyroid carcinoma invading the airway. Ann Thorac Surg 1992; 54: 3-9 DOI: 10.1016/0003-4975(92)91131-r.
• 10 Haugen BR, Alexander EK, Bible KC. et al. American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer. Thyroid 2016; 26: 1-133 DOI: 10.1089/thy.2015.0020.
• 11 Ho AL, Grewal RK, Leboeuf L. et al. Selumetinib-enhanced radioiodine uptake in advanced thyroid cancer. N Engl J Med 2013; 368: 623-632 DOI: 10.1056/NEJMoa1209288.
• 12 Honings J, Stephen JA, Marres HA. et al. The management of thyroid carcinoma invading the larynx or trachea. Laryngoscope 2010; 120: 682-689 DOI: 10.1002/lary.20800.
• 13 Lim H, Devesa SS, Sosa JA. et al. Trends in thyroid cancer incidence and mortality in the United States, 1974–2013. JAMA 2017; 317: 1338-1348 DOI: 10.1001/jama.2017.2719.
• 14 Liu C, Chen T, Liu Z. Associations between BRAFV600E and prognostic factors and poor outcomes in papillary thyroid carcinoma: a meta-analysis. World J Surg Oncol 2016; 14: 241 DOI: 10.1186/s12957-016-0979-1.
• 15 Madariaga ML, Gaissert HA. Secondary tracheal tumors: a systematic review. Ann Cardiothorac Surg 2018; 7 (02) 183-196 DOI: 10.21037/acs.2018.02.01.
• 16 Mansour J, Sagiv D, Alon E. et al. Prognostic value of lymph node ratio in metastatic papillary thyroid carcinoma. J Laryngol Otol 2018; 132: 8-13 DOI: 10.1017/S0022215117002250.
• 17 Musholt TJ. Resektionsstrategien beim lokal fortgeschrittenen Schilddrüsenkarzinom. Chirurg 2020; 91: 1030-1037 DOI: 10.1007/s00104-020-01262-z.
• 18 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 DOI: 10.1016/S0022-5223(97)70120-X.
• 19 Ondik MP, Dezfoli S, Lipinski L. et al. Secondary central compartment surgery for Thyroid Cancer. Laryngoscope 2009; 119: 1947-1950 DOI: 10.1002/lary.20589.
• 20 Park S, Kim WG, Song E. et al. Dynamic risk stratification for predicting recurrence in patients with differentiated thyroid cancer treated without radioactive iodine remnant Ablation Therapy. Thyroid 2017; 27: 524-530 DOI: 10.1089/thy.2016.0477.
• 21 Patel KN, Yip L, Lubitz C. et al. The American Association of endocrine surgeons guidelines for the definitive surgical management of thyroid disease in Adults. Ann Surg 2020; 271: e21-e93 DOI: 10.1097/SLA.0000000000003580.
• 22 Pearson FG, Cooper JD, Nelems JM. et al. Primary tracheal anastomosis after resection of the cricoid cartilage with preservation of recurrent laryngeal nerves. J Thorac Cardiovasc Surg 1975; 70: 806-816 DOI: 10.1016/S0022-5223(19)39664-3.
• 23 Price DL, Wong RJ, Randolph GW. Invasive thyroid cancer: management of the trachea and esophagus. Otolaryngol Clin North Am 2008; 41: 1155 DOI: 10.1016/j.otc.2008.08.002.
• 24 Schlumberger M, Tahara M, Wirth LJ. et al. Levatinib versus placebo in radioiodine-refractory thyroid cancer. N Engl J Med 2015; 372: 621-630 DOI: 10.1056/NEJMoa1406470.
• 25 Shah MH, Wei L, Wirth LJ. et al. Results of randomized phase II trial of dabrafenib versus dabrafenib plus trametinib in BRAF-mutated papillary thyroid carcinoma. Journal of Clinical Oncology 2017; 35 (Suppl. 15) 6022 DOI: 10.1200/JCO.2017.35.15_suppl.6022.
• 26 Suh S, Pak K, Seok JK. et al. Prognostic value of extranodal extension in thyroid cancer: a Meta-analysis. Yonsei Med 2016; J 57: 1324-1328 DOI: 10.3349/ymj.2016.57.6.1324.
• 27 Timman ST, Schoemaker C, Li WW. et al. Functional outcome after (laryngo)tracheal resection and reconstruction for acquired benign (laryngo)tracheal stenosis. Ann Cardiothorac Surg 2018; 7 (02) 227-236 DOI: 10.21037/acs.2018.03.07.
• 28 Tumorregister München. Überleben ICD-10 C73: Papilläres Schilddrüsenca. [Internet]. 2020 [aktualisiert 27.04.2020]. Abrufbar von: https://www.tumorregister-muenchen.de/facts/surv/sC73P_G-ICD-10-C73-Papillaeres-Schilddruesenca.-Survival.pdf
• 29 Vaccarella S, Franceschi S, Bray F. et al. Worldwide thyroid-cancer epidemic? The increasing impact of overdiagnosis. N Engl J Med 2016; 375: 614-617 DOI: 10.1056/NEJMp1604412.
• 30 Wang LY, Palmer FL, Nixon LJ. et al. Lateral neck lymph node characteristics prognostic of outcome in patients with clinically evident N1b papillary thyroid cancer. Ann Surg Oncol 2015; 22: 3530-3536 DOI: 10.1245/s10434-015-4398-2.