Locally Advanced Thyroid Carcinoma: Tracheal Resections Reconstructed with Calcifying Periost

  • Background/Purpose:
    Patients with thyroid carcinoma invading the trachea are at risk of airway obstruction and when treating this condition surgically, it is important to deal with a possible postoperative dynamic airway collapse.

    We wish to elucidate a surgical technique that can provide a stable airway and describe the procedure, and the outcome with tracheal resection and reconstruction with a vascularized calcifying periosteal flap.

    Methods:
    Twelve patients, treated at Oslo University Hospital in the period 2004-2018 with locally advanced thyroid carcinoma were studied retrospectively. Patients underwent thyroid surgery and window resection of the trachea. Reconstruction of the tracheal defect was carried out by a periosteal flap from the clavicle, including part of the sternoclavicular joint capsule to gain extra stiffness and strength. The sternal and manubrial head of the sternocleid muscle was kept attached to the mobilized periosteum to provide vascularization. Temporary stenting of the airway at the end of the procedure was done either by a T-tube or a tracheostomy-cannula. The surgical technique used was based on tracheal reconstruction introduced by Friedman in the late 1980’s[1].

    Primary outcome of this study was a stable airway and no need for further airway stenting. Secondary outcome was morbidity and mortality.

    Results:
    Eleven of twelve patients were decannulated after surgery. Postoperative examination with CT-scan showed calcification of the reconstructed trachea.

    Discussion & Conclusion:  
    Tracheal reconstruction with a periosteal flap showed good results regarding a cannula-free and stable airway. For selected patients, this procedure may prevent lethal complications from thyroid cancer invading the airways.

 

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