title: The role of operations for distantly metastatic well-differentiated thyroid carcinoma.
abstract: 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.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Stojadinovic
authors.forename: Margo
authors.initials: M
authors.lastname: Shoup
authors.forename: Ronald A
authors.initials: RA
authors.lastname: Ghossein
authors.forename: Aviram
authors.initials: A
authors.lastname: Nissan
authors.forename: Murray F
authors.initials: MF
authors.lastname: Brennan
authors.forename: Jatin P
authors.initials: JP
authors.lastname: Shah
authors.forename: Ashok R
authors.initials: AR
authors.lastname: Shaha
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000503:physiopathology / Q000556:secondary / Q000601:surgery; D002277:Carcinoma / Q000473:pathology* / Q000556:secondary* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D010146:Pain / Q000503:physiopathology; D010166:Palliative Care; D012189:Retrospective Studies; D012983:Soft Tissue Neoplasms / Q000556:secondary / Q000601:surgery; D016019:Survival Analysis; D013964:Thyroid Neoplasms / Q000473:pathology*