title: Thoracic metastasectomy for thyroid malignancies.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: John Roland
authors.initials: JR
authors.lastname: Porterfield
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Cassivi
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Wigle
authors.forename: K Robert
authors.initials: KR
authors.lastname: Shen
authors.forename: Francis C
authors.initials: FC
authors.lastname: Nichols
authors.forename: Clive S
authors.initials: CS
authors.lastname: Grant
authors.forename: Mark S
authors.initials: MS
authors.lastname: Allen
authors.forename: Claude
authors.initials: C
authors.lastname: Deschamps
mesh_terms: D018249:Adenoma, Oxyphilic / Q000556:secondary / Q000601:surgery; D000328:Adult; D000368:Aged; D018276:Carcinoma, Medullary / Q000556:secondary / Q000601:surgery; D002291:Carcinoma, Papillary / Q000556:secondary / Q000601:surgery; D018265:Carcinoma, Papillary, Follicular / Q000556:secondary / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016019:Survival Analysis; D013899:Thoracic Neoplasms / Q000556:secondary* / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult