Tracheal and Crico-Tracheal Resection and Anastomosis for Malignancies Involving the Thyroid Gland and the Airway
Tracheal and Crico-Tracheal Resection and Anastomosis for Malignancies Involving the Thyroid Gland and the Airway
复制标题
DOI：
10.1177/0003489415599000
复制
发表时间：
2016-02-01
影响因子：
1.4
通讯作者：
Nicolai, Piero
中科院分区：
文献类型：
--
作者：
Piazza, Cesare;Del Bon, Francesca;Nicolai, Piero
目的：评估结果在不同的恶性肿瘤，涉及甲状腺和浸润的气道提交气管（TRA）或环状气管切除和吻合术（CTRA）。方法：回顾性图表审查27例甲状腺恶性肿瘤，涉及气道治疗TRA/CTRA在一个单一的学术机构。Kaplan-Meier曲线用于评估总体（OS）和疾病特异性（DSS）生存率以及局部（LC）和局部区域控制（LRC）。年龄、合并症、既往放疗、TRA/CTRA类型、Shin分期（II、III、IV）、分级（分化良好与分化不良）和切除气道长度对生存率的影响通过log-rank test.Results计算：3年和5年的总生存率和DSS分别为82.3%和71.6%。3年和5年时，整个组的局部控制和LRC为82.3%。涉及环状软骨弓和板（C型）的环状气管切除和吻合术以及肿瘤分化显著影响OS和DSS（均P <0.001）。C型CTRA和肿瘤分化显著影响LC（P = 0.002和P = 0.009，分别）。结论：CTRA的分级和扩展到环状软骨板是浸润气道的甲状腺恶性肿瘤的肿瘤结局的最重要因素。除了低分化肿瘤，TRA/CTRA允许足够的LC，即使在涉及环气管交界处的晚期病变。
Objectives: To evaluate outcomes in different malignancies involving the thyroid and infiltrating the airway submitted to tracheal (TRA) or crico-tracheal resection and anastomosis (CTRA).Methods: Retrospective charts review of 27 patients affected by thyroid malignancies involving the airway treated by TRA/CTRA in a single academic institution. Kaplan-Meier curves were used to evaluate the overall (OS) and disease-specific (DSS) survivals and local (LC) and loco-regional control (LRC). Impact on survival of age, comorbidities, previous radiotherapy, types of TRA/CTRA, Shin's stage (II, III, IV), grading (well vs poorly differentiated), and length of airway resected was calculated by the log-rank test.Results: Overall survival and DSS at 3 and 5 years were 82.3% and 71.6%, respectively. Local control and LRC in the entire group were 82.3% at 3 and 5 years. Crico-tracheal resection and anastomosis involving the cricoid arch and plate (type C) and tumor differentiation significantly affected OS and DSS (both P < .001). Type C CTRA and tumor differentiation significantly impacted on LC (P = .002 and P = .009, respectively).Conclusions: Grading and extension of CTRA to the cricoid plate are the most important factors for oncologic outcomes in thyroid malignancies infiltrating the airway. Except for poorly differentiated tumors, TRA/CTRA allows adequate LC even in advanced stage lesions involving the crico-tracheal junction.