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Thoracic metastasectomy for thyroid malignancies
European Journal of Cardio-Thoracic Surgery, 07/07/09

Porterfield JR et al. - In a study to better define early and long-term outcomes of pts undergoing thoracic metastasectomy for thyroid cancer, pulmonary resection for thyroid metastasis is safe with low morbidity and mortality. Retrospective analysis demonstrates improved long-term survival in pts with papillary histology, longer disease-free interval and younger age at diagnosis of initial thyroid malignancy.

Methods

Medical records of all pts who underwent thoracic metastasectomy for thyroid cancer were identified, reviewed, and analyzed.

Results

There were 48 pts (25 men, 23 women).
Complete resection (R0) of all known disease was performed in 33 (69%) pts, 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%).
90% 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 in 8 (17%).
Operative mortality was 0 and postoperative complications occurred in 8 pts (17%).
There are currently 18 surviving pts (37%) with median follow-up of 10 yrs.
Overall 5-yr survival after thoracic metastasectomy was 60%.
Based on histology, 5-yr survival for papillary cancer was 64% vs 37% for follicular and Hürthle cell neoplasms.
All 5 medullary thyroid cancer pts were alive at 5 yrs.
5-yr survival was improved for pts <45 yrs old at time of diagnosis of their initial thyroid malignancy (94% vs 49%).
Disease-free interval of >3 yrs between initial thyroid malignancy diagnosis and thoracic metastasectomy demonstrated improved 5-yr survival (67% vs 52%).