title: The role of surgery in anaplastic thyroid cancer: A systematic review.
abstract: OBJECTIVE
  To elucidate the role of surgery in the management of anaplastic thyroid cancer.
  
  
  METHODS
  Ovid MEDLINE, Cochrane Library, and Google Scholar databases were searched for publications from December 2000 to July 2016. Selection criterion was a focus on the management of anaplastic thyroid cancer in adults. Studies addressing only nonsurgical management and review articles were excluded. Data extraction was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Kaplan-Meier analysis was performed on a subset of patients.
  
  
  RESULTS
  40 publications were included in the study. Approaches to unresectability and interpretations of resection varied widely. For patients undergoing primary surgery, the median survival was 6.6months. The median survival for non-surgical patients was 2.1months. In the subgroup analysis, the median survival time for patients undergoing surgery was significantly longer in Stage IVB (p=0.022) but not IVC disease. Negative margins did not afford a statistically significant survival benefit.
  
  
  CONCLUSIONS
  Surgery is a mainstay of treatment for Stage IVA and IVB disease. For Stage IVC cancer, distant metastasis was not a strict criterion against surgical candidacy among surgeons. The extent of resection and the definition of resectability remain controversial. Negative margins did not significantly increase survival.
authors.affiliation: Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, United States. Electronic address: shu@nyee.edu.
authors.forename: Shirley
authors.initials: S
authors.lastname: Hu
authors.affiliation: Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, United States.
authors.forename: Samuel N
authors.initials: SN
authors.lastname: Helman
authors.affiliation: New York Medical College, Valhalla, NY, United States.
authors.forename: Elyse
authors.initials: E
authors.lastname: Hanly
authors.affiliation: Department of Otolaryngology, New York Eye and Ear Infirmary of Mount Sinai, New York, NY, United States; Department of Otolaryngology, Mount Sinai Beth Israel, New York, NY, United States.
authors.forename: Ilya
authors.initials: I
authors.lastname: Likhterov
mesh_terms: D006801:Humans; D009367:Neoplasm Staging; D011379:Prognosis; D065646:Thyroid Carcinoma, Anaplastic / Q000175:diagnosis / Q000601:surgery*; D013964:Thyroid Neoplasms / Q000175:diagnosis / Q000601:surgery*; D013965:Thyroidectomy
keywords: Anaplastic thyroid cancer; Multimodality; Surgery; Surgical management; Thyroid cancer; Thyroidectomy