Abstract

Appropriate surgical and adjuvant therapies for involvement of great vessels in thyroid malignancies have rarely been reported in literature. In this study, we aim to present our experience and provide a review literature of these devastating tumors that requires multidisciplinary intervention during the whole process of management. Among the 118 patients with thyroid malignancies that were presented to us, there were only 2 patients with infiltration of the internal jugular vein. One of these patients underwent segmental resection of internal jugular vein with total thyroidectomy while the other patient had extensive infiltration of internal jugular vein that an extensive radical metastatic lymph nodes resection was not feasible.  A review of the English literature since 1930 revealed an additional 42 cases of internal jugular vein infiltration with or without neck and mediastinal vessel involvements. We have analyzed the surgical and adjuvant therapies that were carried out in all these patients and searched for the parameters including;  type of surgical and adjuvant therapies, rate of survival, duration of survival (months), follow-up period and mortality. Twenty six of the 42 patients (62%) underwent internal jugular vein resection along with thyroidectomy; 13 patients (31%), thrombectomy of tumour thrombus and 7 (17%), reconstruction of the vessel after resection; 5 venous and 2 arterial. Survival among patients who did not undergo resection was for a mean period of 3.9 months and following resection was 26 months (range 4 months to 6 years). Aggressive resection may result in long term survival in some of these patients and may prolong life in others. Surgical approach to patients with thyroid malignancies infiltrating the great vessels may involve thrombectomy or may require resection of the vein and occasionally artery with or without reconstruction. Patients who underwent resection and adjuvant therapy were found to have better survival rate. 

Key words: Thyroidectomy, internal jugular vein resection, neck vein obstruction, thyroid malignancy, running title- thyroid malignancy infiltrating jugular vein.