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This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Stephen D. Cassivi Dennis A. Wigle Francis C. Nichols Mark S. Allen Claude Deschamps Permission Requests Google Scholar Articles by Porterfield, J. R. Articles by Deschamps, C. PubMed Articles by Porterfield, J. R. Articles by Deschamps, C. Related Collections Lung - cancer Mediastinum

Thoracic metastasectomy for thyroid malignancies

Division of General Thoracic Surgery, Mayo Clinic, 200 First Street, SW, Rochester, Minnesota, USA

Received 22 June 2008; received in revised form 14 December 2008; accepted 19 December 2008.

^_* Corresponding author. Tel.: +1 507 266 0911; fax: +1 507 284 0058. (Email: cassivi.stephen{at}mayo.edu).

Objective: To better define early and long-term outcomes of patients undergoing thoracic metastasectomy for thyroid cancer. Methods: We identified, reviewed, and analyzed the medical records of all patients who underwent thoracic metastasectomy for thyroid cancer in our institution from 1971 to 2006. Results: There were 48 patients (25 men, 23 women). A complete resection (R0) of all known disease was performed in 33 (69%) patients, while 15 (31%) underwent incomplete resection (R1 or R2). By histology, the majority were papillary 31 (65%), follicular 8 (17%), medullary 5 (10%), and Hürthle cell 4 (8%). Ninety percent were confined to a single side of the chest, with 10% presenting with bilateral metastases. Thoracotomy was performed in 28 (58%), sternotomy in 12 (25%), and thoracoscopy was used in 8 (17%). Operative mortality was zero and postoperative complications occurred in 8 patients (17%). There are currently 18 surviving patients from the cohort (37%) with a median follow-up of 10 years (range, 1 month to 17 years). The overall 5-year survival after thoracic metastasectomy was 60%. Based on histology, 5-year survival for papillary cancer was 64% compared to 37% for follicular and Hürthle cell neoplasms (p = 0.03). All five medullary thyroid cancer patients were alive at 5 years. Five-year survival was also improved for patients less than 45 years old at the time of diagnosis of their initial thyroid malignancy (94% vs 49%; p = 0.03). Disease-free interval of >3 years between initial thyroid malignancy diagnosis and thoracic metastasectomy demonstrated improved 5-year survival (67% vs 52%; p = 0.01). Conclusion: Pulmonary resection for thyroid metastasis is safe with low morbidity and mortality. Retrospective analysis demonstrates improved long-term survival in patients with papillary histology, longer disease-free interval (>3 years) and younger age at diagnosis of initial thyroid malignancy. Excellent long-term survival was also achievable in selected patients with medullary thyroid metastasis.

Key Words: Thoracic metastasectomy • Thyroid metastasis • Pulmonary metastasectomy • Thyroid cancer