Surgery 2002 Jun;131(6):636-43
The role of operations for distantly metastatic well-differentiated thyroid
carcinoma.
Stojadinovic A, Shoup M, Ghossein RA, Nissan A, Brennan MF, Shah JP, Shaha AR.
BACKGROUND: The role of operations for distantly metastatic well-differentiated
thyroid carcinoma (DTC) is poorly defined. We review the indications for
operation for metastatic DTC. METHODS: This study consists of 260 patients
treated between 1941 and 2000 for metastatic DTC, of which 59 (23%) underwent
operations. Median follow-up was 7 years (range, 1 to 49 years). Metastases were
identified clinically in 157 (60%) and radiologically in 103 (40%) patients. The
disease-specific survival was estimated with the Kaplan-Meier method. RESULTS:
Twenty-four patients (9%) were disease-free with resection. Palliative resection
was indicated for painful bone metastasis, pathologic fracture, or symptomatic
spinal cord involvement (35/260, 14%). Patients who could undergo complete
metastasectomy survived longer than those having incomplete/palliative resection
or nonoperative treatment for metastatic DTC (5-year disease-specific survival,
78% vs 43% vs 46%, P =.03). CONCLUSIONS: Solitary distant metastasis of DTC
amenable to complete resection is infrequent. Complete metastasectomy may be
associated with improved survival for localized distant disease. Palliative
resection is indicated to improve quality of life for symptomatic distant
metastasis.
