Thyroidectomy And Hypoparathyroidism In Patients With Pharyngoesophageal Tumors

Background. Total pharyngolaryngoesophagectomy and gastric transposition (TPLEGT) for pharyngoesophageal (PE) tumors may require thyroidectomy (with or without removal of the parathyroid glands) to obtain adequate margins around the tumor. As a result, a considerable number of patients may have hypoparathyroidism (HP) develop. The objective of this article is to report our experience with different types of thyroidectomy and to describe the relationship of thyroidectomy to HP in TPLETG. These results are compared with data in the literature. Methods. From 1985 to 2001, 40 patients underwent TPLEGT, with main index tumors in the esophagus (n = 17), hypopharynx (n = 17), and larynx (n = 6). All patients had advanced cTNM or pTNM stages (III or IV). Postoperative HP was diagnosed based primarily on the symptoms and calcium and phosphorus analysis but not on parathyroid hormone (PTH) levels. Results. Total thyroidectomy (TT) was done in 12 (30%) patients and 11 (91.6%) had permanent HP develop. In none of these patients was the parathyroid separated and implanted (fear of a tumor implant). Partial thyroidectomy (PT) (lobectomy and isthmus) was done in 25 (62.5%) patients, and permanent HP occurred in 11 (44%) patients. The thyroid was preserved in three patients, and none had HP develop. Of the 40 patients, 13 (32.5%) had no HP, five (12.5%) had temporary HP, and 22 (55%) had permanent HP. There was a correlation between the type of thyroidectomy, location of primary tumors, and development of HP. Only seven reports in the past 30 years have dealt with TPLEGT, thyroidectomy, and HP. HP occurred in 32.5% of the cases of TT and in 19.5% of the cases of PT. Conclusions. Permanent HP was very frequent (55%) in our series. In patients who underwent TPLEGT, HP was almost certain when TT was done (91.6%). PT was no guarantee that HP would not occur (44% permanent HP). The frequency of permanent HP based on primary index tumors was 47%, 59%, and 66.6% for esophageal, hypopharyngeal, and laryngeal cancer, respectively. © 2005 Wiley Periodicals, Inc.282135141Ong, G.B., Lee, T.C., Pharyngogastric anastomosis after oesophagopharyngectomy for carcinoma of the hypopharynx and cervical oesophagus (1960) Br J Surg, 48, pp. 193-200Buchanan, G., West, T.E., Woodhead, J.S., Lowy, C., Hypoparathyroidism following pharyngolaryngo-oesophagectomy (1975) Clin Oncol, 1, pp. 89-96Harrison, D.F.N., Surgical management of hypopharyngeal cancer. Particular reference to the gastric pull-up operation (1979) Arch Otolaryngol, 105, pp. 149-152Lam, K.H., Ong, J., Lim, S.T.K., Ong, G.B., Pharyngogastric anastomosis following pharyngolaryngoesophagectomy: Analysis of 157 cases (1981) World J Surg, 5, pp. 509-516Spiro, R.H., Shah, J.P., Strong, E.W., Gerold, F.P., Bains, M.S., Gastric transposition in head and neck surgery, indications, complications, expectations (1983) Am J Surg, 146, pp. 483-487Collin, C.F., Spiro, R.H., Carcinoma of the cervical esophagus: Changing therapeutic trends (1984) Am J Surg, 148, pp. 460-465Wei, W.I., Lam, K.L., Choi, S., Wong, J., Late problems after pharyngolaryngoesophagectomy and pharyngogastric anastomosis for cancer of the larynx and hypopharynx (1984) Ann J Surg, 14, pp. 509-513Krespi, Y.P., Wurster, C.F., Wang, T.D., Stone, D.M., Hypoparathyroidism following total pharyngolaryngoesophagectomy and gastric pull-up (1985) Laryngoscope, 10, pp. 1184-1187Orringer, M.B., Transhiatal esophagectomy without thoracotomy for carcinomas of the esophagus (1986) Adv Surg, 19, pp. 1-49Pradhan, S.A., Post-cricoid cancer: An overview (1989) Semin Surg Oncol, 5, pp. 331-336Spiro, R.H., Bains, M.S., Shah, J.P., Strong, E.W., Gastric transposition for head and neck cancer: A critical update (1991) Am J Surg, 162, pp. 348-352Orringer, M.B., Anterior mediastinal tracheostomy with and without cervical exenteration (1992) Ann Thorac Surg, 54, pp. 628-637Cahow, C.E., Sasaki, C.T., Gastric pull-up reconstruction for pharyngo-laryngo-esophagectomy (1994) Arch Surg, 129, pp. 425-430Wei, W.I., Lam, K.L., Yuen, P.W., Current status of pharyngolaryngo-esophagectomy and pharyngogastric anastomosis (1998) Head Neck, 20, pp. 240-244Martins, A.S., Gastric transposition for pharyngoesophageal tumors: Unicamp experience (2000) J Laryngol Otol, 114, pp. 682-689Martins, A.S., Multicentricity in pharyngoesophagic tumors: Argument for total pharyngolaryngoesophagectomy (2000) Head Neck, 22, pp. 156-163Martins, A.S., Neck and mediastinal node dissection in pharyngoesophageal tumors (2001) Head Neck, 23, pp. 772-779Schobinger, R., The use of long anterior skin flap in radical neck dissection (1957) Ann Surg, 146, pp. 221-223Eckert, C., Byars, L.T., The surgery of papillary carcinoma of the thyroid gland (1952) Ann Surg, 136, pp. 83-89Isaacson, S.R., Snow, J.B., Etiologic factors in hypocalcemia secondary to operations for carcinoma of the pharynx and larynx (1978) Laryngoscope, 88, pp. 1290-1297Paloyan, E., Lawrence, A.M., Paloyan, D., Successful autotransplantation of the parathyroid glands during total thyroidectomy for carcinoma (1977) Surg Gynecol Obstet, 145, pp. 364-368Wells, A.S., Ross, A.J., Dale, J.K., Gray, R.S., Transplantation of the parathyroid gland: Current status (1979) Surg Clin North Am, 59, pp. 167-177. , Symposium on Endocrine SurgeryThompson, N.W., Harness, J.K., Complications of total thyroidectomy for carcinoma (1970) Surg Gynecol Obstet, 15, pp. 861-868Perzik, S.L., Catz, B., The place of total thyroidectomy in the management of thyroid disease (1967) Surgery, 62, pp. 436-44