Extralaryngeal Spread in Total Laryngectomy: Comparing the Need for Thyroidectomy

Introduction: At our institution, preservation of thyroid during total laryngectomy (TL) is surgeon dependent and therefore provides a unique dataset comparing disease outcomes between patients undergoing TL with or without thyroidectomy.

Methods: Study

Design: Retrospective study.

Setting: Tertiary referral center.

Patients: Patients who underwent TL for resection of laryngeal or hypopharyngeal squamous cell carcinoma (SCC) at a single institution between 2014 to 2022 were included in the study.

Main Outcome Measures: Data included patient demographics, surgeries performed, pathological staging and analysis, subsites involved by tumor, and thyroid invasion by direct extension or metastasis. Long term follow up included adjuvant therapies recommended, status of completion, and recurrence rates.

Results: 147 patients met inclusion criteria. Majority of the patients were male (83%) and Caucasian (82%). 60 patients underwent hemi thyroidectomy, 35 total or completion, 48 had no thyroid (NT) removed, and 4 had isthmusectomy. Data were run between the four groups and between the cohort of NT versus any thyroidectomy (T = 99). Of those 99 patients, 27 of them had positive gland involvement, 26 of which were from direct extension of disease. There was no significant difference of recurrence rates or death from recurrence between the four groups or between NT and T (p > 0.05). There was a significant difference between T staging and prognostic staging between the four groups and between NT versus T (p < 0.05). The cohort NT was more likely to be T3 whereas T was more likely to be T4.

Conclusions: At our institution, there was no significant difference between recurrence rates or death from recurrence in patients who had no thyroid removed during total laryngectomy versus those who underwent any type of thyroidectomy, however, those who had no thyroid removed were more likely to be of a lower T stage.