Sparing Surgery for the Successful Treatment of Thyroid Papillary Carcinoma Invading the Trachea: A Case Report

Abstract

Published reports on salvage treatment for trachea reconstruction after total thyroidectomy or partial tracheotomy are available, some of them using structures of the trachea itself, auricular cartilage, a musculocutaneous flap, or other methods. In our report, we emphasize the importance of a search for a new material and approach for sparing surgery. The purpose of this article is to describe a case of a successful sparing surgery in a patient with advanced thyroid papillary carcinoma invading the trachea. After total thyroidectomy in 2012, partial resection of the trachea was performed in 2014. The lesion defect was 5.5 × 2.3 cm in size, located between 4 (2nd-6th) tracheal cartilaginous rings and involving about a semicircumference. It was reconstructed with the aid of the knitted TiNi-based mesh endograft, which has been prefabricated in the sternocleidomastoid muscle and further covered with the skin draped over the wound. The tracheostoma was fully closed 6 weeks after the surgery. There were neither side effects nor complications. This kind of tracheal surgery for extensive lesions demonstrates good functional and cosmetic outcomes.

Keywords: Knitted TiNi-based mesh endograft; Prefabrication; Sparing surgery; Thyroid papillary carcinoma; Tracheal reconstruction.

Fig. 1

Cervical MRI showing a thyroid carcinoma invading the tracheal wall and deformed tracheal lumen.

Fig. 2

Outline of the suggested treatment. The defect of the trachea is reconstructed with the prefabricated KTNME and covered with the skin draped over the wound.

Fig. 3

The first-stage intraoperative findings. a Before U-shape incision. b The thyroid mass is removed, and a window resection is made. c The resected tumor specimen is shown. d The prepared KTNME is implanted into the sternocleidomastoid muscle. e A tracheal window is made with a local skin flap.

Fig. 4

Three weeks after the tracheal window resection. Postoperative appearance of the patient and cervical MRI showing the implanted KTNME and no stenosis.

Fig. 5

The second-stage intraoperative findings. a Demarcation and O-shape incision. The harvested KTNME is separated (b) and overturned to reconstruct the tracheal defect (c). d The sliding skin flap is swung over the wound. e Postoperative fiberoptic endoscopy before discharge reveals no stenosis or granulation tissue of the lumen, which is well epithelialized.