Radical surgical treatment of locally advanced thyroid cancer

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The result of radical treatment of locally advanced thyroid cancer with metastases to the regional lymph nodes of the neck on the left, with tissue breakdown and skin fistula formation, is presented. An 84-year-old female patient has severe concomitant pathology, such as ischemic heart disease, widespread atherosclerosis, cardiosclerosis, and permanent atrial fibrillation (tachy form, Grade 2A). A conglomerate of lymph nodes with disintegration in the projection of the external jugular vein and possible profuse bleeding was considered an absolute indication for surgery, which was performed on February 10, 2015. Considering the conglomeration of the lymph nodes of the neck, which displaced the trachea to the right, an endoscopist was called in, who performed tracheal intubation through the nose using a fiberoptic bronchoscope. The surgical treatment included combined thyroidectomy, a Crile’s operation on the left side, and the removal of the conglomerate of the lymph nodes of the neck as well as the adjacent area of the skin in a single block. The postoperative period was uneventful. On the second day after surgery, the patient was examined by an endocrinologist. The prescribed treatment was L-thyroxine 75 mg once a day in the morning. On the fifth day, the patient was discharged with recovery to be treated in the outpatient clinic by an oncologist and an endocrinologist.

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About the authors

Sergey D. Fokeev

Altai Regional Oncological Dispensary

Author for correspondence.
Email: fokeev.sergey@yandex.ru
ORCID iD: 0000-0002-1157-6692
SPIN-code: 9609-0896

MD, Dr. Sci. (Med.), Associate Professor

Russian Federation, Barnaul

Alexander F. Lazarev

Altai Regional Oncological Dispensary

Email: lazarev@akzs.ru
ORCID iD: 0000-0003-1080-5294
SPIN-code: 1161-8387

MD, Dr. Sci. (Med.), Professor

Russian Federation, Barnaul

Yuriy I. Savenkov

Altai Regional Oncological Dispensary

Email: sawenkov.savva@yandex.ru
SPIN-code: 6867-2999

MD, Cand. Sci. (Med.), Associate Professor

Russian Federation, Barnaul

Stanislav Yu. Kapitulin

Altai Regional Oncological Dispensary

Email: stass0331429@mail.ru
ORCID iD: 0000-0001-8131-3161
SPIN-code: 1217-0508

MD, Cand. Sci. (Med.), Associate Professor

Russian Federation, Barnaul

Elena S. Kazantseva

Novosibirsk Research Institute of Traumatology & Orthopedics

Email: ktyf1984@yandex.ru
ORCID iD: 0000-0003-3575-047X
SPIN-code: 5074-1757

MD, Cand. Sci. (Med.)

Russian Federation, Novosibirsk

Elina K. Kapitulina

City Hospital No. 5

Email: elinalevina4@gmail.com
ORCID iD: 0000-0002-3856-2012
Russian Federation, Barnaul


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Supplementary files

Supplementary Files
1. Fig. 1. Conglomerate of lymph nodes in the neck, skin fistula.

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2. Fig. 2. Gross specimen: rudinoclavicular mastoid muscle, internal jugular vein, conglomerate of cervical lymph nodes with disintegration and adjacent skin area.

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3. Fig. 3. The surgical wound after radical surgical treatment.

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