title: Optimal surgical procedure for locally curative surgery in patients with anaplastic thyroid carcinoma: importance of preoperative ultrasonography.
abstract: Anaplastic thyroid carcinoma (ATC) is a very aggressive disease showing a high mortality. However, long-term survival is expected when patients do not show distant metastasis at diagnosis and undergo locally curative surgery. In this study, we investigated the optimal surgical procedure for locally curative surgery for ATC in a series of 34 patients. Twenty patients underwent total thyroidectomy but there were no detectable skip lesions of ATC in the contralateral lobe on pathological examination. Cause-specific survival (CSS) of Stage IVA or IVB patients who underwent limited thyroidectomy did not differ from that of those who underwent total thyroidectomy. Clinical node metastasis on ultrasonography was not detected in 15 patients but 11 of these patients underwent lymph node dissection. Three of these were node-positive on pathological examination but only one showed metastatic node of ATC that was involved in the primary lesion. Of 19 patients having clinical node metastasis, 10 were ATC node positive on pathological examination. Taken together, for locally curative surgery in ATC patients, 1) total thyroidectomy may not be mandatory unless patients have clinical lesions in the contralateral lobe; 2) prophylactic modified radical neck dissection may not be mandatory for patients who do not demonstrate clinical signs of lymph node metastasis; and 3) extensive and careful therapeutic node dissection may be required for patients demonstrating clinical signs of node metastasis.
authors.affiliation: Department of Surgery, Kuma Hospital, Kobe, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Higashiyama
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ito
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Hirokawa
authors.forename: Hiroo
authors.initials: H
authors.lastname: Masuoka
authors.forename: Tomonori
authors.initials: T
authors.lastname: Yabuta
authors.forename: Mitsuhiro
authors.initials: M
authors.lastname: Fukushima
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Inoue
authors.forename: Minoru
authors.initials: M
authors.lastname: Kihara
authors.forename: Chisato
authors.initials: C
authors.lastname: Tomoda
authors.forename: Yuuki
authors.initials: Y
authors.lastname: Takamura
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Akihiro
authors.initials: A
authors.lastname: Miya
authors.forename: Akira
authors.initials: A
authors.lastname: Miyauchi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018287:Carcinoma, Large Cell / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection / Q000379:methods; D009364:Neoplasm Recurrence, Local; D011300:Preoperative Care; D011379:Prognosis; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods; D014463:Ultrasonography