Appropriateness of Subadventitial Resection for Invasion of the Carotid Artery by Papillary Thyroid Carcinoma

• Published in: World journal of surgery 2019-02, Vol.43 (2), p.519-526
• Main Author: Moritani, Sueyoshi
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Cardiac Surgery; Carotid arteries; Carotid artery; General Surgery; Medical prognosis; Medicine; Medicine & Public Health; Original Scientific Report; Papillary thyroid carcinoma; Patients; Preservation; Surgery; Survival; Thoracic Surgery; Thyroid; Thyroid cancer; Tumors; Vascular Surgery; Veins & arteries; Vertebrae
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-018-4787-3

Background Selection of surgical treatment for patients with papillary thyroid carcinoma (PTC) that includes great vessel invasion is challenging. We investigated the efficacy of tumor excision, with regard to safety of the surgical procedure and prognosis among patients with PTC invasion of the carotid or vertebral artery. Methods This study is a retrospective review of patients who underwent surgical excision for PTC at our institution, between 1981 and 2010, with 49 patients treated for carotid artery invasion and nine for vertebral artery invasion. Results Twenty patients with carotid artery invasion receiving initial treatment underwent subadventitial resection. Among 29 relapsing patients with carotid artery invasion, subadventitial resection was performed in 27 and en-block resection and reconstruction in the other two. In patients with carotid artery invasion, locoregional recurrence was identified in 14 patients, with the recurrence specific to the carotid artery in one case and distant recurrence in 15. The 10-year disease-specific survival rate was shorter among relapsing patients (21.7%) than among those receiving an initial treatment (69.3%). At 8 years after surgery, however, the survival rates were comparable between the two groups. Of the nine patients with vertebral artery invasion, two received initial treatment, with either preservation or reconstruction of the vertebral artery. The other six cases were tumor recurrences, treated by tumor and vertebral artery resection. Vertebral artery invasion was associated with carotid artery invasion in five patients and subclavian artery invasion in four. Conclusions Carotid artery invasion by PTC did not extend beyond the adventitia of the artery in the majority of patients. Most patients with vertebral artery invasion required tumor excision with vertebral artery resection.