Difficulties of tracheotomy in patients with anaplastic thyroid carcinoma

Anaplastic thyroid carcinoma (ATC) is an extremely destructive tumor with a median survival time not longer than eight months. ATC often presents with a swiftly expanding neck mass causing loco-regional symptoms. The trachea is outside the normal position due to pushing by the mass, likewise, the palpation of the trachea is impossible due to the increased rigid irregular tumor tissue between the skin and trachea. Vocal cord paralysis is possible or the tumor can invade the tracheal lumen. Airway management should always have the priority. Imaging evaluation should be scheduled efficiently as such information is critical for planning the tracheotomy. Tracheotomy should be executed to support ventilation in circumstances of life-threatening upper airway obstruction. Given these patients' short life expectancy, a balanced decision on the role and timing of tracheotomy must be achieved. This review provides fundamental knowledge on ATC patient tracheotomy from an objective perspective.