Subadventitial dissection for removal of a papillary thyroid carcinoma encasing the common carotid artery: case report

Abstract

This research aims to describe the surgical management of a patient with advanced papillary thyroid carcinoma that has completely encircled the common carotid artery. A woman who had a gradually enlarging thyroid mass over 20 years presented with progressive dysphagia and hoarseness for 3 months. Computed Tomography (CT) of neck revealed a huge thyroid mass completely encasing the common carotid artery. Doppler ultrasonography demonstrated patent flow and intact intima without transmural infiltration. The tumor was excised off the carotid artery in a subadventitial plane. Minimal residual tumor extending into the retrosternal region was treated with postoperative radioiodine therapy. Histopathology report of the specimen confirmed a papillary thyroid carcinoma. The use of Doppler ultrasonography, careful preoperative planning and the technique of subadventitial dissection are crucial for a safe and successful outcome in advanced papillary thyroid carcinoma with involvement of the common carotid artery.