Surgical management of laryngotracheal and esophageal involvement by locally advanced thyroid cancer.

Well-differentiated thyroid cancer usually progresses slowly and rarely invades other tissues. However, the rare cases with invasion of local structures, such as the larynx, trachea, or esophagus, present particular management difficulties. In situations with limited involvement of the larynx or trachea, there is controversy over whether a "shave excision" that may leave microscopic disease at the site, or a complete resection that includes removal of a portion of these structures is the better approach. In the case of more extensive involvement of upper aerodigestive tract structures by thyroid carcinomas, the most appropriate method of resection and reconstruction is also at issue. We discuss the literature pertaining to the surgical management of laryngotracheal and esophageal invasion by thyroid carcinoma, review the incidence and presentation of this disease, and make recommendations based on our own experience.