{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T05:46:46Z","timestamp":1782452806086,"version":"3.54.5"},"reference-count":18,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T00:00:00Z","timestamp":1781740800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/jcm15124758","type":"journal-article","created":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T13:04:04Z","timestamp":1781874244000},"page":"4758","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical Management and Outcomes in Advanced Thyroid Cancer: Insights from a Single-Institution Experience"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1473-6962","authenticated-orcid":false,"given":"Mario","family":"Pacilli","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2523-4914","authenticated-orcid":false,"given":"Giovanna","family":"Pavone","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth","family":"Khoury","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Ambrosi","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6845-7080","authenticated-orcid":false,"given":"Nicola","family":"Tartaglia","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1038\/s41574-025-01168-y","article-title":"Unravelling the rise in thyroid cancer incidence and addressing overdiagnosis","volume":"22","author":"Chen","year":"2026","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.1089\/thy.2016.0064","article-title":"Management of invasive differentiated thyroid cancer","volume":"26","author":"Nixon","year":"2016","journal-title":"Thyroid"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1089\/thy.2016.0547","article-title":"Molecular profiling of papillary thyroid carcinoma in Korea with a high prevalence of BRAFV600E mutation","volume":"27","author":"Lee","year":"2017","journal-title":"Thyroid"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1002\/hed.27025","article-title":"American Head and Neck Society Endocrine Surgery Section and International Thyroid Oncology Group consensus statement on mutational testing in thyroid cancer: Defining advanced thyroid cancer and its targeted treatment","volume":"44","author":"Shonka","year":"2022","journal-title":"Head Neck"},{"key":"ref_5","first-page":"e73956","article-title":"Advanced unresectable differentiated thyroid cancer with anaplastic transformation: A case report and review of the literature","volume":"16","author":"Alzahrani","year":"2024","journal-title":"Cureus"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"4806","DOI":"10.2174\/0929867327666200214125712","article-title":"Clinical and translational challenges in thyroid cancer","volume":"27","author":"Hernando","year":"2020","journal-title":"Curr. Med. Chem."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1089\/thy.2020.0944","article-title":"2021 American Thyroid Association guidelines for management of patients with anaplastic thyroid cancer","volume":"31","author":"Bible","year":"2021","journal-title":"Thyroid"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"105204","DOI":"10.12998\/wjcc.v13.i25.105204","article-title":"Risk factors and outcomes of metastatic poorly differentiated thyroid carcinoma","volume":"13","author":"Hsu","year":"2025","journal-title":"World J. Clin. Cases"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"S75","DOI":"10.1016\/j.ijsu.2015.12.036","article-title":"Thyroid cancer invading the airway: Diagnosis and management","volume":"28","author":"Avenia","year":"2016","journal-title":"Int. J. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1646","DOI":"10.1089\/thy.2019.0145","article-title":"Routine preoperative laryngoscopy for thyroid surgery is not necessary without risk factors","volume":"29","author":"Maher","year":"2019","journal-title":"Thyroid"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"350","DOI":"10.5946\/ce.2014.47.4.350","article-title":"Primary papillary thyroid carcinoma diagnosed by using endoscopic ultrasound with fine needle aspiration","volume":"47","author":"Jalil","year":"2014","journal-title":"Clin. Endosc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"262","DOI":"10.14740\/wjon899w","article-title":"The role of tracheostomy in anaplastic thyroid carcinoma","volume":"6","author":"Xu","year":"2015","journal-title":"World J. Oncol."},{"key":"ref_13","first-page":"161","article-title":"Bilateral central neck dissection in the treatment of early unifocal papillary thyroid carcinomas with poor risk factors: A mono-institutional experience","volume":"91","author":"Tartaglia","year":"2020","journal-title":"Ann. Ital. Chir."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.amjoto.2017.02.005","article-title":"The role of surgery in anaplastic thyroid cancer: A systematic review","volume":"38","author":"Hu","year":"2017","journal-title":"Am. J. Otolaryngol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3527","DOI":"10.1007\/s00432-022-04223-7","article-title":"Role of surgery to the primary tumor in metastatic anaplastic thyroid carcinoma: Pooled analysis and SEER-based study","volume":"149","author":"Oliinyk","year":"2023","journal-title":"J. Cancer Res. Clin. Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"461","DOI":"10.21873\/invivo.12279","article-title":"Radiation to the primary tumor in metastatic anaplastic thyroid cancer","volume":"35","author":"Augustin","year":"2021","journal-title":"In Vivo"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2311","DOI":"10.1007\/s00268-014-2536-9","article-title":"Anaplastic thyroid carcinomas incidentally found on postoperative pathological examination","volume":"38","author":"Yoshida","year":"2014","journal-title":"World J. 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