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The role of surgery in the current management of differentiated thyroid cancer

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Abstract

In the last decades, a surprising increased incidence of differentiated thyroid cancer (DTC), along with a precocious diagnosis of “small” tumors and microcarcinomas have been observed. In these cases, better oncological outcomes are expected, and a “tailored” and “less aggressive” multimodal therapeutic protocol should be considered, avoiding an unfavorable even if minimal morbidity following an “overtreatment.” In order to better define the most suitable surgical approach, its benefits and risks, we discuss the role of surgery in the current management of DTCs in the light of data appeared in the literature. Even if lymph node metastases are commonly observed, and in up to 90 % of DTC cases micrometastases are reported, the impact of lymphatic involvement on long-term survival is still argument of intensive research, and indications and extension of lymph node dissection (LD) are still under debate. In particular, endocrine and neck surgeons are still divided between proponents and opponents of routine central LD (RCLD). Considering the available evidence, there is agreement about total thyroidectomy, therapeutic LD in clinically node-positive DTC patients, and RCLD in “high risk” cases. Nevertheless, indications to the best surgical treatment of clinically node-negative “low risk” patients are still subject of research. Considering on the one hand, the recent trend toward routine central lymphadenectomy, avoiding radioactive treatment, and on the other hand, the satisfactory results obtained reserving prophylactic LD to “high risk” patients, we think that further prospective randomized trials are needed to evaluate the best choice between the different surgical approaches.

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Authors and Affiliations

  1. VII Division of General and Endocrine Surgery, Department of Anesthesiologic, Surgical and Emergency Sciences, School of Medicine, Second University of Naples, Via Sergio Pansini 5, 80131, Naples, Italy

    Giovanni Conzo, Giancarlo Candela & Luigi Santini

  2. Endocrine Surgery Unit, University of Perugia, Perugia, Italy

    Nicola Avenia & Andrea Polistena

  3. Department of Medical, Surgical, Neurological, Metabolic and Geriatric Sciences, Second University of Naples, Naples, Italy

    Giuseppe Bellastella

  4. Endocrinology Unit, Department of Cardio-Thoracic and Respiratory Sciences, Second University of Naples, Naples, Italy

    Annamaria de Bellis, Daniela Pasquali & Antonio Agostino Sinisi

  5. Department of Clinical and Experimental Medicine, Second University of Naples, Naples, Italy

    Katherine Esposito

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  1. Giovanni Conzo
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  2. Nicola Avenia
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Correspondence to Giovanni Conzo.

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Conzo, G., Avenia, N., Bellastella, G. et al. The role of surgery in the current management of differentiated thyroid cancer. Endocrine 47, 380–388 (2014). https://doi.org/10.1007/s12020-014-0251-9

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  • DOI: https://doi.org/10.1007/s12020-014-0251-9

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