Abstract
Objective
To elucidate the role of surgery in the management of anaplastic thyroid cancer.
Methods
Ovid MEDLINE, Cochrane Library, and Google Scholar databases were searched for publications from December 2000 to July 2016. Selection criterion was a focus on the management of anaplastic thyroid cancer in adults. Studies addressing only nonsurgical management and review articles were excluded. Data extraction was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Kaplan-Meier analysis was performed on a subset of patients.
Results
40 publications were included in the study. Approaches to unresectability and interpretations of resection varied widely. For patients undergoing primary surgery, the median survival was 6.6 months. The median survival for non-surgical patients was 2.1 months. In the subgroup analysis, the median survival time for patients undergoing surgery was significantly longer in Stage IVB (p = 0.022) but not IVC disease. Negative margins did not afford a statistically significant survival benefit.
Conclusion
Surgery is a mainstay of treatment for Stage IVA and IVB disease. For Stage IVC cancer, distant metastasis was not a strict criterion against surgical candidacy among surgeons. The extent of resection and the definition of resectability remain controversial. Negative margins did not significantly increase survival.
1
Introduction
Anaplastic thyroid carcinoma (ATC) is a highly aggressive form of thyroid cancer, with a reported median survival rate of only 4 months. While multimodal therapy is frequently advocated, the precise role of surgery for patients with advanced disease is unclear. The approach to surgical management for patients with ATC varies across institutions and surgeons. Studies have drawn conflicting conclusions regarding aggressiveness of tumor resection in the presence of extrathyroidal extension. Some experts have concluded that patients undergoing radical resection with negative margins have no survival benefit over those with positive microscopic or macroscopic margins . Other authors have shown that complete resection is a positive prognostic factor . Likewise, in patients with tumors considered unresectable, the role of debulking or ultraradical surgery has been debated. We perform the first systematic review of the role of surgery in the management of ATC with the goal of developing a framework or algorithm for decision-making.
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