Emergency Tracheostomy in Locally Advanced Anaplastic Thyroid Cancer

Ripu Daman Arora; Karthik Nagaraja Rao; Satish Satpute; Rupa Mehta; Prajwal Dange; Nitin M Nagarkar; A P Abishek

doi:10.1007/s13193-023-01753-5

Emergency Tracheostomy in Locally Advanced Anaplastic Thyroid Cancer

Indian J Surg Oncol. 2023 Sep;14(3):714-722. doi: 10.1007/s13193-023-01753-5. Epub 2023 Apr 26.

Authors

Ripu Daman Arora¹, Karthik Nagaraja Rao², Satish Satpute¹, Rupa Mehta¹, Prajwal Dange², Nitin M Nagarkar³, A P Abishek¹

Affiliations

¹ Department of Otolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, Raipur, India.
² Department of Head and Neck Oncology, All India Institute of Medical Sciences, Raipur, Chhattisgarh 492099 India.
³ All India Institute of Medical Sciences, Raipur, India.

PMID: 37900643
PMCID: PMC10611692 (available on 2024-09-01)
DOI: 10.1007/s13193-023-01753-5

Abstract

Over 30% of cases may present with acute airway obstruction due to anaplastic thyroid cancer (ATC). In such situations, performing an emergency tracheostomy may be mandatory to save the life. A retrospective, single-centre study at our centre was conducted between 1 January 2021 to 31 December 2022. We had included 17 patients with asphyxia due to ATC and subsequently underwent tracheostomy for stridor. The overall survival (OS) ranged from 2 days to 16 months (median = 11 months). The 30-day mortality was 17.6%. One-year overall survival was 36%. A statistically significant difference in the OS among patients with distant metastasis and Shin grade IV tracheal infiltration (p < 0.001, Log Rank (Mantel-Cox), CI:95%). The degree of tracheal deviation correlated with the patent age group (Pearson chi-square (pc), p = 0.031), type of anaesthesia used local versus general (pc, p < 0.001) and site of tracheostoma (pc, p = 0.028). The degree of tracheal infiltration correlated with the presence of distant metastasis (pc, p = 0.01) and OS (pc, p = 0.013). Tracheostomy in patients with ATC is performed in extreme circumstances to support an airway. Patients often require isthmectomy to obtain adequate access for a tracheostomy, highlighting the importance of having a highly experienced surgeon involved. An attempt to perform the tracheostomy in the ward or the emergency room under local anaesthesia should be avoided. Patients and relatives should be educated to communicate evolving issues and tracheostomy care in the patient's best interests, given the unusual context of ATC. Level of evidence, IV.

Keywords: Anaplastic thyroid cancer; Head and neck cancer; Thyroid cancer; Thyroid gland; Tracheostomy.

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