Aims: To describe the surgical management, perioperative outcomes, and survival of patients with anaplastic thyroid carcinoma (ATC) undergoing operative intervention at a single metropolitan tertiary centre, and to identify factors associated with resection completeness and prognosis. Methodology: A retrospective audit was performed on all patients who underwent surgery for ATC at Eastern Health, Victoria, Australia between 2023-2025. Data extracted included demographics, presenting symptoms, airway status, details of surgical procedures, resection margins, pathological stage, post-operative complications, BRAF status, adjuvant therapy, and survival outcomes. Results: A total of three surgical patients were identified. Median age was 64 years, and 33.3% were female. All cases presented with a rapidly enlarging neck mass. Surgical procedures included total thyroidectomy (+/-central neck dissection) and right hemithyroidectomy and right neck dissection. Complete (R0/R1) resection was achieved in 66.6% of cases, with none requiring airway intervention perioperatively. Post-operative complications were a unilateral vocal cord palsy and surgical emphysema. 66.6% received adjuvant therapy, most commonly external beam radiotherapy and chemotherapy. Patients who had R0 or R1 resections had better survival outcomes. Factors associated with improved survival included younger age and use of adjuvant treatment with chemoradiation. Conclusion: This series demonstrates that well selected ATC patients may benefit from surgical intervention, with resection completeness strongly associated with survival. These findings support the 2024 American Thyroid Association (ATA) guidelines, which recommend surgery only when meaningful resection is achievable without delaying systemic therapy. Our data reinforce the importance of early multidisciplinary triage, timely operative decision-making, and integration of adjuvant therapies to optimise outcomes in this aggressive malignancy.