Surgical strategy of locally advanced differentiated thyroid cancer
Surgical strategy of locally advanced differentiated thyroid cancer
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DOI：
10.1016/j.anl.2022.03.005
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发表时间：
2023-01-23
影响因子：
1.7
通讯作者：
Inohara, Hidenori
中科院分区：
文献类型：
--
作者：
Enomoto, Keisuke;Inohara, Hidenori
在分化型甲状腺癌(DTC)患者中，约有20%的患者肿瘤直接侵犯周围组织，如喉、气管、食道或喉返神经。分子靶向治疗的最新进展，如使用酪氨酸激酶抑制剂，可以改善晚期DTC患者的生存结果。然而，对于局部晚期的DTC，酪氨酸激酶抑制剂的诱导出现了新的致命不良事件，包括向气管、咽和食道渗透的患者发生瘘管，以及大血管侵犯患者发生致命出血。因此，外科手术在DTC管理中仍然发挥着重要作用，特别是在局部控制方面。DTC常见的喉气管侵犯的手术策略是根据肿瘤的范围(深度和面积)来决定的。当肿瘤表面侵袭到喉部/气管时，就会进行“剃须手术”。然而，腔内扩张需要切除和重建喉/气管壁。大静脉，如颈内静脉和锁骨下静脉，也经常被DTC直接侵犯。根据双侧颈静脉结扎术，已提倡三种类型的颈静脉重建术以避免致命的并发症。大多数DTC侵犯的颈动脉可以通过切除肿瘤外膜下层而不使用人工血管进行重建手术来处理。在这篇综述文章中，我们检查了晚期DTC的外科治疗，展示了对侵犯喉气管、喉返神经、食道/下咽或大血管的DTC的手术策略。(C)2022日本耳鼻喉科学会-头颈外科公司。由Elsevier B.V.出版。保留所有权利。
Approximately 20% of patients with differentiated thyroid cancer (DTC) have direct tumor exten-sion with invasion of the surrounding tissues such as the larynx, trachea, esophagus, or recurrent laryngeal nerve. Recent progress of molecular-targeted therapy, such as the use of tyrosine ki-nase inhibitors, improves survival outcome in patients with advanced DTC. However, induction of tyrosine kinase inhibitors for locally-advanced DTC has presented novel fatal adverse events including fistula in patients with infiltration toward to the trachea, pharynx and esophagus, and fatal bleeding in patients with great vessel invasion. Surgery therefore still has an important role in DTC management, particularly in local control. The surgical strategy for laryngeal/tracheal invasion, which commonly occurs by DTC, is decided according to the extension (depths and area) of the tumor. The "shave procedure" is performed when the tumor has superficially invaded the larynx/trachea. However, intra-luminal extension requires resection and reconstruction of the larynx/trachea wall. Large veins, such as the internal jugular vein and the subclavian vein, are also frequently directly invaded by DTC. Three types of jugular vein reconstruction have been advocated to avoid fatal complications according to bilateral jugular vein ligation. The majority of carotid artery invasion by DTC can be managed with tumor resection of the sub-adventitial layer without reconstruction surgery using an artificial vessel. In this review article, we exam-ine surgery for advanced DTC, showing the surgical strategy toward DTC that has invaded the laryngotracheal, recurrent laryngeal nerve, esophagus/hypopharynx, or great vessels.(c) 2022 Japanese Society of Otorhinolaryngology-Head and Neck Surgery, Inc. Published by Elsevier B.V. All rights reserved.