Features of upper airway resection and reconstruction methods in cases of invasion by locally advanced malignant thyroid tumors

Background. Extrathyroidal spread of locally advanced malignant thyroid tumors with invasion into the upper respiratory tract significantly reduces the effectiveness of multimodal treatment. Clear indications and contraindications for using airway resection and reconstruction methods have not been established and may depend on the location and extent of invasion, as well as the degree of tumor differentiation. Aim of the study was to determine the optimal methods of upper airway resection and reconstruction according to the location and extent of tumor invasion from malignant thyroid neoplasms and their morphological differentiation in order to improve treatment outcomes. Materials and methods. At the Center for Endocrine Surgery of the Mechnikov Dnipropetrovsk Regional Clinical Hospital, 66 patients with locally advanced malignant thyroid tumors involving laryngotracheal invasion underwent comprehensive treatment, which included clinically radical extended thyroidectomy combined with different upper airway resection techniques: 24 patients with early invasion underwent tumor “shaving” from the airway wall; 21 had window resections with staged airway reconstruction; 8 underwent wedge resections; 11 had circumferential airway resections with immediate reconstruction; 2 underwent total laryngectomy. Results. Advantages and disadvantages of each upper airway resection method were identified. The study analyzed procedure-specific complications, treatment outcomes, local recurrence rates, and 5-year survival. Methods for improving each resection and reconstruction technique were proposed. Based on the findings, clear indications and contraindications were established for each method depending on the location and extent of invasion and, where relevant, the degree of tumor differentiation. Conclusions. Tumor “shaving” may be recommended only for early invasion by highly differentiated tumors. Wedge resection has significant limitations in cases of large tumor size and tumors with low or intermediate morphological differentiation. In cases of extensive invasion, especially involving laryngeal structures, window resection of the upper airway appears more effective than circumferential resection for tumors of any differentiation grade.