Combined and complex treatment of high-differential local-distributed cancer of the thyroid gland

Abstract

Aim. To evaluate the results of combined and integrated treatment in patients with locally advanced thyroid cancer. Material and Methods. From 2004 to 2018, we operated 1,693 patients with differentiated thyroid cancer; the incidence of locally advanced cancer of the thyroid gland was 5.2%. In the case of tumours spreading beyond the thyroid gland, patients were subjected to fibro-laringotracheoscopy, fibro-esophagoscopy, spiral computer or magnetic resonance imaging (1.5 T) of the neck and upper mediastinum, dopplerography, and computer angiography of the neck arteries. Results and Discussion. The most commonly reported cases of tumor invasion were invasions into the upper airways (56 (63.6%) patients). Of all patients with locally advanced cancer, 25 (28.4%) had combined lesions of vital structures. All patients received surgical treatment depending on degree and nature of the spreading of the tumor process. Conclusions. Performing surgical interventions allows increasing the indicators of three-year survival to 83% and reduces the number of cases of recurrence of the disease to 21%. Execution of the trachea resection (up to 3 rings) allows instant removal and closure of the defect in case of the upper airways damage. However, when removing 3 or 4 rings, there is a need for projective tracheostomy to prevent the phenomena of insolvency of seams. Performing neoadjuvant polychemotherapy in a group of patients with highly differentiated cancers can achieve regression of the tumor and transform it into an operable one.

Keywords

• local-distributed cancer of the thyroid gland, complex treatment, combined operations, thyroidectomy