A 16-Year Single-Center Series of Trachea Resections for Locally Advanced Thyroid Carcinoma

Simple Summary Infiltration of the aerodigestive tract determines the prognosis in advanced thyroid carcinoma, ultimately leading to suffocation. To avoid this fatal outcome, surgical treatment strategies-within the framework of multidisciplinary patient care-are required. There are no established guidelines to rely on, and an individualized surgical treatment approach is required. The aim of this study was to present and critically analyze the stepwise escalatory surgical treatment strategy, which was applied over a 16-year time period at the University Medical Center Mainz, in respect to the resulting recurrence-free survival. The feasibility of stage-adapted tracheal resections is illustrated by the present study. Despite the risk of potentially life-threatening complications from the operations, prolonged recurrence-free and overall survival were observed in the institutional cohort of patients suffering from high-stage thyroid carcinoma.Abstract (1) Background: Infiltration of the aerodigestive tract in advanced thyroid carcinoma determines the prognosis and quality of life. Different stages of tracheal tumor invasion require customization of the surgical concept. (2) Methods: In the period from January 2007 to January 2023, patients who underwent surgery for advanced thyroid carcinomas with trachea resections were included in a retrospective observational study. The surgical resection concepts and operation-associated complications were documented. The overall survival and post-resection survival were analyzed. (3) Results: From 2007 to 2023, at the single-center UMC Mainz, 33 patients (15 female and 18 male) underwent neck surgery with trachea resections for locally advanced thyroid carcinomas. Of these, 14 were treated with non-transmural (trachea shaving) and 19 transmural trachea resections (9 "window" resections, 6 near-circular resections, 3 sleeve resections and 1 total laryngectomy with extramucosal esophageal resection). The two-year postoperative survival rate was 82.0 percent. The two-year recurrence-free survival rate was 75.0 percent (mean follow-up period: 29.2 months). (4) Conclusions: Tracheal resections for locally advanced tumor infiltration are feasible as an element of highly individualized treatment concepts.