Thoracic metastasectomy for thyroid malignancies

John Roland Porterfield, Stephen D. Cassivi, Dennis A Wigle, K. Robert Shen, Francis C. Nichols, Clive S. Grant, Mark S. Allen, Claude Deschamps

Research output: Contribution to journalArticle

11 Citations (Scopus)

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). Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)155-158
Number of pages4
JournalEuropean Journal of Cardio-thoracic Surgery
Volume36
Issue number1
DOIs
StatePublished - Jul 2009

Fingerprint

Metastasectomy
Thyroid Gland
Thorax
Neoplasms
Survival
Histology
Neoplasm Metastasis
Thyroid Neoplasms
Thoracoscopy
Sternotomy
Mortality
Thoracotomy
Medical Records

Keywords

  • Pulmonary metastasectomy
  • Thoracic metastasectomy
  • Thyroid cancer
  • Thyroid metastasis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pulmonary and Respiratory Medicine
  • Surgery

Cite this

Porterfield, J. R., Cassivi, S. D., Wigle, D. A., Shen, K. R., Nichols, F. C., Grant, C. S., ... Deschamps, C. (2009). Thoracic metastasectomy for thyroid malignancies. European Journal of Cardio-thoracic Surgery, 36(1), 155-158. https://doi.org/10.1016/j.ejcts.2008.12.055

Thoracic metastasectomy for thyroid malignancies. / Porterfield, John Roland; Cassivi, Stephen D.; Wigle, Dennis A; Shen, K. Robert; Nichols, Francis C.; Grant, Clive S.; Allen, Mark S.; Deschamps, Claude.

In: European Journal of Cardio-thoracic Surgery, Vol. 36, No. 1, 07.2009, p. 155-158.

Research output: Contribution to journalArticle

Porterfield, JR, Cassivi, SD, Wigle, DA, Shen, KR, Nichols, FC, Grant, CS, Allen, MS & Deschamps, C 2009, 'Thoracic metastasectomy for thyroid malignancies', European Journal of Cardio-thoracic Surgery, vol. 36, no. 1, pp. 155-158. https://doi.org/10.1016/j.ejcts.2008.12.055
Porterfield, John Roland ; Cassivi, Stephen D. ; Wigle, Dennis A ; Shen, K. Robert ; Nichols, Francis C. ; Grant, Clive S. ; Allen, Mark S. ; Deschamps, Claude. / Thoracic metastasectomy for thyroid malignancies. In: European Journal of Cardio-thoracic Surgery. 2009 ; Vol. 36, No. 1. pp. 155-158.
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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 H{\"u}rthle 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 H{\"u}rthle 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). Conclusion: 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.",
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AB - 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). Conclusion: 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.

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