Frequency of Thyroid Gland Invasion by Laryngeal Squamous Cell Carcinoma: The Role of Subglottic Extension

 

 Permissions and Reprints

Abstract

Introduction Management of the thyroid gland during laryngectomy has been controversial. The primary tumor may invade the thyroid gland by direct invasion or lymphovascular spread. Hypothyroidism and hypoparathyroidism are potential risks when lobectomy or total thyroidectomy are performed simultaneously.

Objective To report the frequency of thyroid gland involvement by primary laryngeal squamous cell carcinoma in patients undergoing laryngectomy and to identify possible risk factors for thyroid gland involvement so that judicious excision of thyroid gland can be attained.

Methods We performed a retrospective review of 9 years. Data was collected from medical records of patients dated from December 2009 to October 2018. All patients with laryngeal cancer who underwent laryngectomy with lobectomy or total thyroidectomy were included in the present study.

Results We reviewed 151 laryngectomy records. A total of 130 surgeries included the thyroid gland with the excised specimen and were available for analysis. There were 124 males and 6 females. The mean age was 59.4 years old. The glottis was the most common subsite involved, in 70 patients, followed by 38 transglottic, 16 supraglottic and 03 subglottic tumors. On histology, 12 out of 130 excised thyroid glands were involved by squamous cell carcinoma. Only subglottic involvement (p = 0.01) was significantly associated with thyroid gland invasion (TGI). Type of laryngectomy, subsite of the primary tumor, thyroid cartilage involvement, neck nodal metastases, and perineural and lymphatic invasion by the primary tumor were not associated with TGI.

Conclusion Only subglottic involvement is associated with TGI; therefore, preoperative and intraoperative assessment is necessary prior to considering excision of the thyroid gland.

Disclosure

None.

Publication History

Received: 02 June 2020

Accepted: 27 September 2021

Article published online:
08 February 2022

© 2022. Fundação Otorrinolaringologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

• References

• 1 Sparano A, Chernock R, Laccourreye O, Weinstein G, Feldman M. Predictors of thyroid gland invasion in glottic squamous cell carcinoma. Laryngoscope 2005; 115 (07) 1247-1250
  CrossrefPubMedGoogle Scholar
• 2 Gilbert RW, Cullen RJ, van Nostrand AW, Bryce DP, Harwood AR. Prognostic significance of thyroid gland involvement in laryngeal carcinoma. Arch Otolaryngol Head Neck Surg 1986; 112 (08) 856-859
  CrossrefPubMedGoogle Scholar
• 3 Elliott MS, Odell EW, Tysome JR. et al. Role of thyroidectomy in advanced laryngeal and pharyngolaryngeal carcinoma. Otolaryngol Head Neck Surg 2010; 142 (06) 851-855
  CrossrefPubMedGoogle Scholar
• 4 Dadas B, Uslu B, Cakir B, Ozdoğan HC, Caliş AB, Turgut S. Intraoperative management of the thyroid gland in laryngeal cancer surgery. J Otolaryngol 2001; 30 (03) 179-183
  CrossrefPubMedGoogle Scholar
• 5 Croce A, Moretti A, Bianchedi M. [Thyroid gland involvement in cancer of the larynx]. Acta Otorhinolaryngol Ital 1991; 11 (04) 429-435
  PubMedGoogle Scholar
• 6 Al-Hakami HA, Al Garni MA, AlSubayea H. et al. The incidence of thyroid gland invasion in advanced laryngeal squamous cell carcinoma. Rev Bras Otorrinolaringol (Engl Ed) 2019
  Google Scholar
• 7 Mawaddah A, See-Sze S, Marina M, Pua K, Abdullah-Sani M. The Incidence of Thyroid Gland Invasion in Patients with Carcinoma of the Larynx who Underwent Total Laryngectomy. Int Med J Malays 2019;18(01):
  Google Scholar
• 8 Arslanoğlu S, Eren E, Özkul Y. et al. Management of thyroid gland invasion in laryngeal and hypopharyngeal squamous cell carcinoma. Eur Arch Otorhinolaryngol 2016; 273 (02) 511-515
  CrossrefPubMedGoogle Scholar
• 9 Holgado JWA, Grullo PER, Gloria JDLS, Pontejos Jr AQY. Thyroid Gland Involvement in Advanced Laryngeal Squamous Cell Carcinoma. Acta Med Philipp 2017;51(01):
  Google Scholar
• 10 Vitamog MCF, Castañeda SS. Thyroid Gland Invasion in Laryngeal Carcinoma. Philippine Journal of Otolaryngology Head and Neck Surgery. 2017; 32 (02) 22-24
  CrossrefGoogle Scholar
• 11 Kumar R, Drinnan M, Robinson M. 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 (05) 372-378
  CrossrefPubMedGoogle Scholar
• 12 Donnelly MJ, O'Meara N, O'Dwyer TP. Thyroid dysfunction following combined therapy for laryngeal carcinoma. Clin Otolaryngol Allied Sci 1995; 20 (03) 254-257
  CrossrefPubMedGoogle Scholar
• 13 Kim JW, Han GS, Byun SS, Lee DY, Cho BH, Kim Y-M. Management of thyroid gland invasion in laryngopharyngeal cancer. Auris Nasus Larynx 2008; 35 (02) 209-212
  CrossrefPubMedGoogle Scholar
• 14 Al-Khatib T, Mendelson AA, Kost K. et al. Routine thyroidectomy in total laryngectomy: is it really indicated?. J Otolaryngol Head Neck Surg 2009; 38 (05) 564-567
  Google Scholar
• 15 Iype EM, Jagad V, Nochikattil SK, Varghese BT, Sebastian P. Thyroid gland involvement in carcinoma larynx and hypopharynx-predictive factors and prognostic significance. J Clin Diagn Res 2016; 10 (02) XC05-XC07
  PubMedGoogle Scholar
• 16 Biel MA, Maisel RH. Indications for performing hemithyroidectomy for tumors requiring total laryngectomy. Am J Surg 1985; 150 (04) 435-439
  CrossrefPubMedGoogle Scholar
• 17 Yuen AP, Wei WI, Lam KH, Ho CM. Thyroidectomy during laryngectomy for advanced laryngeal carcinoma–whole organ section study with long-term functional evaluation. Clin Otolaryngol Allied Sci 1995; 20 (02) 145-149
  CrossrefPubMedGoogle Scholar
• 18 Strome SE, Robey TC, Devaney KO, Krause CJ, Hogikyan ND. Subglottic carcinoma: review of a series and characterization of its patterns of spread. Ear Nose Throat J 1999; 78 (08) 622-624 , 626, 628 passim
  CrossrefPubMedGoogle Scholar
• 19 Mozumder S, Chatterjee K, Dubey S, Dam A, Bhowmick AK, Contrast CT. Scan Evaluation of Incidence and Pattern of Thyroid Gland Involvement in Locally Advanced Ca Larynx Modifying the Need of Routine Thyroidectomy with Total Laryngectomy. Indian J Otolaryngol Head Neck Surg 2019; •••: 1-3
  Google Scholar
• 20 Mendelson AA, Al-Khatib TA, Julien M, Payne RJ, Black MJ, Hier MP. Thyroid gland management in total laryngectomy: meta-analysis and surgical recommendations. Otolaryngol Head Neck Surg 2009; 140 (03) 298-305
  CrossrefPubMedGoogle Scholar
• 21 Gurunathan RK, Panda NK, Das A, Karuppiah S. Thyroid gland in carcinoma of the larynx and hypopharynx: analysis of factors indicating thyroidectomy. J Otolaryngol Head Neck Surg 2008; 37 (03) 435-439
  Google Scholar
• 22 Chang JW, Koh YW, Chung WY, Hong SW, Choi EC. Predictors of thyroid gland involvement in hypopharyngeal squamous cell carcinoma. Yonsei Med J 2015; 56 (03) 812-818
  CrossrefPubMedGoogle Scholar
• 23 Li SX, Polacco MA, Gosselin BJ, Harrington LX, Titus AJ, Paydarfar JA. Management of the thyroid gland during laryngectomy. J Laryngol Otol 2017; 131 (08) 740-744
  CrossrefPubMedGoogle Scholar
• 24 Mangussi-Gomes J, Danelon-Leonhardt F, Moussalem GF, Ahumada NG, Oliveira CL, Hojaij FC. Thyroid gland invasion in advanced squamous cell carcinoma of the larynx and hypopharynx. Rev Bras Otorrinolaringol (Engl Ed) 2017; 83 (03) 269-275
  Google Scholar
• 25 Baghel SS, Singhal P, Verma N. et al. Is thyroid excision mandatory with laryngectomy in carcinoma larynx?. BMC Cancer 2020; 20 (01) 700
  CrossrefPubMedGoogle Scholar
• 26 Plaat RE, van Dijk BAC, Muller Kobold AC. et al. Onset of hypothyroidism after total laryngectomy: Effects of thyroid gland surgery and preoperative and postoperative radiotherapy. Head Neck 2020; 42 (04) 636-644
  CrossrefPubMedGoogle Scholar
• 27 Janardhan D, Varghese BT, Iype EM, Thomas S. Hypothyroidism in surgically treated T4 hypopharyngeal and laryngeal cancers. International Journal of Otorhinolaryngology and Head and Neck Surgery. 2017; 3 (04) 968
  CrossrefGoogle Scholar
• 28 Panda S, Kumar R, Konkimalla A. et al. Rationale behind thyroidectomy in total laryngectomy: analysis of endocrine insufficiency and oncological outcomes. Indian J Surg Oncol 2019; 10 (04) 608-613
  CrossrefPubMedGoogle Scholar
• 29 Mourad M, Saman M, Sawhney R, Ducic Y. Management of the thyroid gland during total laryngectomy in patients with laryngeal squamous cell carcinoma. Laryngoscope 2015; 125 (08) 1835-1838
  CrossrefPubMedGoogle Scholar
• 30 Vermund H, Krajci P, Eide TJ, Winther F. Laryngectomy whole organ serial sections–histological parameters correlated with recurrence rate. Acta Oncol 2004; 43 (01) 98-107
  CrossrefPubMedGoogle Scholar
• 31 Gorphe P, Ben Lakhdar A, Tao Y, Breuskin I, Janot F, Temam S. Evidence-based management of the thyroid gland during a total laryngectomy. Laryngoscope 2015; 125 (10) 2317-2322
  CrossrefPubMedGoogle Scholar
• 32 McGuire JK, Viljoen G, Rocke J, Fitzpatrick S, Dalvie S, Fagan JJ. Does Thyroid Gland Preserving Total Laryngectomy Affect Oncological Control in Laryngeal Carcinoma?. Laryngoscope 2019
  Google Scholar