The thyroid gland adjoins the trachea, pharynx, esophagus, carotid artery and cervical
skin. Most thyroid carcinomas have been treated at lower stages; however, in some
cases the carcinomas have invaded the surrounding organs. After resecting invasive
thyroid carcinomas, the defects vary depending on the invasion area and organs affected;
subsequent reconstructive methods vary depending on the size of defect and its components.
This study analysed the pattern of defects and the reconstructive methods used following
invasive thyroid carcinoma resection.
From April 2011 to March 2021, 665 patients in Saitama Cancer Center (Saitama, Japan)
were diagnosed with thyroid carcinoma and subsequently underwent thyroidectomies.
In the 25 patients (3.8%), the thyroid carcinoma invaded surrounding organs and any
reconstructive surgery—including end-to-end tracheal anastomosis and simple pharynx
closure—was performed after thyroid carcinoma resection. The patients’ records were
retrospectively reviewed, and the defects and subsequent reconstructive methods were
When our new classification system was applied to the defects, the number of cases
for each type was totaled: Tr0: 1; Tr1a: 3; Tr2b: 5; Tr3a: 1; La-Tr3b+PE2: 7; La-Tr3b+PE2+S2:
1; PE1: 1; PE1+S1: 2; S1: 2; S2: 2. For Tr0, a tracheal fenestration was performed
after the tumor resection and the fenestration was closed with a hinge flap. For Tr1a
defect, a tracheal fenestration was performed with cervical skin after the tumor resection
and the tracheal fenestration was closed with a deltopectoral flap or pectralis major
musculocutaneous flap. In one recent patient, the tracheal fenestration was reconstructed
using free forearm flap and cervical skin, and the fenestration was closed with a
hinge flap. For Tr2b defect, free forearm flap and costal cartilage graft reconstruction
was performed after the tumor resection and the fenestration was closed with a hinge
flap. For Tr3a defect, end-to-end anastomosis was performed in one patient. For La-Tr3b+PE2
defect, total pharyngolaryngectomy with free jejunal flap reconstruction was performed.
For PE1 defect, a simple closure was performed in one patient and a PMMC muscle flap
was used for covering the suture line in two patients. For S1 and S2 defect, PMMC
flap or DP flap was used.
Our analysis of defects and reconstructive methods defines the complex defect patterns
occurring after invasive thyroid carcinoma resection, describes the patterns of subsequent