Discussion:
Involvement of airway has been reported in 6% - 21% of patients
undergoing thyroid surgery [10-12]. Among patients with invasive
DTC, 37% demonstrate tracheal invasion. Intraluminal tracheal
involvement is less frequent, occurring in 0.5% - 1.5% [13-14].
While recurrent laryngeal nerve damage does not independently influence
survival, esophageal and tracheal invasion has been shown to impact
survival [15]. The complete resection of the trachea to remove
neoplasm that does not invade the mucosa is controversial [16-17].
Partial tracheal involvement without mucosal invasion can be treated by
partial resection and has a favorable outcome.However, a larger area of
mucosal invasion may limit the feasibility of partial tracheal resection
because it may lead to kinking or stenosis after repair. Hence full
circumference resection and end to end anastomosis is preferred to
shaving trachea. Although extensive involvement of the trachea like 6 or
more tracheal ring and simultaneous invasion of the esophagus remains
contradiction for the procedure. One of the major advantages of tracheal
resection is the immediate and effective relief of intratracheal
bleeding and the symptoms of obstruction. Hence in our opinion, trachea
should be resected and anastomosed whenever needed for better short- and
long-term outcome.
Conclusion: Thyroid cancer invading trachea is a rare entity in
differentiated thyroid cancer. But in case of recurrent disease partial/
focal infiltration can be expected. Unfortunately, in this case, the
thyroid cartilage infiltration was ≥3 cm invading the
3rd tracheal ring. Small resection of trachea is easy
to perform but for of 3-4 cm defect only. Tracheal mobilization and
hyoid are the method to bring together the cut ends to be anastomosed.
This requires high degree of skill and utmost precaution of tracheal
vascularity with intervention for further speech.
Conflict of Interest: The authors have stated explicitly that
there are no conflicts of interest in connection with this paper.