Treatment of locally advanced thyroid cancer invading the great vessels using a Y-shaped graft bypass

Abstract

Although the presence of aggressive angioinvasion is not a contraindication for surgical treatment of well-differentiated thyroid cancer, surgical resection and reconstruction of the major arteries in the neck and mediastinum using a synthetic graft is rarely performed. We present our experience of resection and reconstruction of the major arteries in the neck for the treatment of locally advanced thyroid cancer. A 66-year-old woman presented with locally advanced thyroid cancer with invasion of the right internal jugular vein and vagus nerve. The cancer mass encased the junction of the right common carotid artery, the subclavian artery, and the brachiocephalic trunk. After en-bloc resection of the tumor, the arteries were reconstructed using a Y-shaped synthetic graft between the common carotid artery, aorta, and the subclavian artery. Postoperatively, there was no evidence of cerebral ischemia and the patient made a rapid recovery without complications. An aggressive surgical approach is appropriate for grossly invasive thyroid cancer to decrease the risk of local recurrence and increase survival. Surgical resection and reconstruction of the major arteries in the neck and chest using a synthetic graft can be an acceptable therapeutic option for locally advanced thyroid cancer. © 2010 Published by European Association for Cardio-Thoracic Surgery.