Pharyngolaryngoesophagectomy for well-differentiated papillary thyroid carcinoma widely invading the upper aerodigestive tract*

MA (WDPTC) shows good prognosis even with lymphatic gland involvement. Although invasion of the upper aerodigestive tract by WDPTC is rare, it results in serious morbidity and mortality.1,2 The prognosis of WDPTC invading the upper aerodigestive tract appears to correlate with the site and depth of invasion.3,4 Extensive invasion of these structures produces dyspnea, dysphagia, and hemoptysis. Life-threatening airway hemorrhage and suffocation due to airway invasion by the carcinoma are common direct causes of death from WDPTC,5 and surgery for such patients remains a challenge. Wide resection of the invaded structure sometimes causes the patient significant inconvenience, including loss of voice. However, incomplete resection of the lesion results in early recurrence.6 Adequate local control of invasive WDPTC is therefore an important clinical consideration. Grillo and Zannini7 reported pharyngolaryngoesophagectomy for locally advanced or recurrent papillary thyroid carcinoma, which widely invades both the trachea and esophagus. PATIENTS AND SURGICAL PROCEDURE We performed pharyngolaryngoesophagectomy for WDPTC with laryngotracheo-esophageal or tracheoesophageal invasion (Table). Three patients had primary disease and 2 had recurrent disease after a subtotal or total thyroidectomy. Patient 1 had undergone a total thyroidectomy and shave excision for tracheal invasion of the tumor. Patient 5 had undergone circumferential sleeve resection of the trachea concomitantly to total thyroidectomy. Neither of these 2 patients had been treated with 131I therapy or external-beam radiotherapy. Three patients complained of dyspnea due to stenosis of the trachea derived from invasion of the tumor. Two patients had hemoptysis, which strongly suggested transmural invasion of the tumor. Bronchoscopy, performed on all patients but patient 4, confirmed tracheal invasion. Patient 4 underwent emergency tracheostomy due to suffocation following intratracheal bleeding on the day of admission. Wide and transmural invasion of the larynx and/or trachea had been detected in all patients preoperatively. Two patients, who had previously undergone a thyroidectomy, were diagnosed with WDPTC by histological examination following the first surgery. The other 3 patients were diagnosed with WDPTC after total thyroidectomy with pharyngolaryngoesophagectomy. All 5 patients were therefore diagnosed with WDPTC. Bilateral pulmonary metastases were detected by chest roentgenography before surgery in patients 2 and 3. Pharyngolaryngoesophagectomy was initially intended for 4 of the 5 patients, with patient 4 Brief clinical reports