Surgical Management and Outcomes in Advanced Thyroid Cancer: Insights from a Single-Institution Experience

Background: The role of surgery in advanced thyroid cancer remains controversial, particularly in the setting of aggressive tumor behavior, local invasion, and limited therapeutic windows. Advanced thyroid cancer represents a heterogeneous clinical entity that includes anaplastic thyroid carcinoma as well as differentiated and poorly differentiated carcinomas with aggressive features. Methods: We conducted a retrospective case series of 10 consecutive patients who underwent surgical management for advanced thyroid cancer at a tertiary referral center over a 30-month period. Clinical presentation, surgical strategy, postoperative complications, adjuvant therapies, and outcomes were analyzed. Results: The cohort included 2 papillary, 5 poorly differentiated, and 3 anaplastic thyroid carcinomas. Most patients presented with locally invasive disease and compressive symptoms, including dysphonia and dyspnea. Complete resection (R0) was achieved in five patients and was associated with favorable outcomes, while patients with anaplastic histology experienced poor survival despite palliative interventions. Surgery provided meaningful symptom control in selected patients, particularly those with airway compromise. No perioperative mortality occurred. Conclusions: Surgical management of advanced thyroid cancer should be highly individualized and guided by tumor extent, symptom burden, and patient performance status. While surgery alone is insufficient as a standalone treatment, it plays a pivotal role when integrated within a multimodal strategy, offering both oncologic and palliative benefits. Early identification of candidates for surgical intervention and integration with systemic therapies represent key elements in the management of these complex malignancies.