Surgical treatment of anaplastic thyroid cancer

Abstract

Anaplastic thyroid cancer is the least common but also the most lethal malignancy of the thyroid gland. At the time of diagnosis, all patients are considered as stage IV patients, while nodal disease does not affect the staging of the disease. Surgery is only indicated in cases without infiltration of adjacent structures or distant metastasis. R0 resection is considered as providing the favourable surgical result, but R1 resection is also acceptable since adjuvant postoperative radiotherapy has a mainly palliative role. Radioactive Iodine ablation is not considered beneficial for these patients and is of no use. Central and/or lateral compartment dissection is recommended as an option in surgical treatment since anaplastic cancer has a tendency for regional nodal spread. Tracheotomy and/or tracheal stenting is still debatable and can be used in some cases as part of palliative therapy in order to avoid suffocation. The aggressiveness of anaplastic cancer along with its invasive character make preoperative laryngoscopy necessary as many patients already have vocal cord palsy caused by tumour invasion of the recurrent laryngeal nerve. Proper staging prior to surgery with CT, MRI or other imaging modalities to exclude or confirm infiltration of adjacent structures or distant metastasis is also required. In the majority of patients, there is insufficient time to plan the appropriate therapy because of the tumour’s aggressive behaviour. Patients have a median survival of 4 to 6 months, while over 80% fail to survive more than a year.