Faculty Collaboration Database

Thyroid surgery for differentiated thyroid cancer - recent advances and future directions. Nat Rev Endocrinol 2018 Nov;14(11):670-683

Date

08/23/2018

Pubmed ID

30131586

DOI

10.1038/s41574-018-0080-7

Scopus ID

2-s2.0-85052566056 (requires institutional sign-in at Scopus site)   159 Citations

Abstract

Population-based studies have demonstrated that an increasing number of incidental thyroid nodules are being identified. The corresponding increase in thyroid-based diagnostic procedures, such as fine-needle aspiration biopsy, has in part led to an increase in the diagnoses of thyroid cancers and to more thyroid surgeries being performed. Small papillary thyroid cancers account for most of this increase in diagnoses. These cancers are considered to be low risk because of the excellent patient outcomes, with a 5-year disease-specific survival of >98%. As a result, controversy remains regarding the optimal management of newly diagnosed differentiated thyroid cancer, as the complications related to thyroidectomy (primarily recurrent laryngeal nerve injury and hypoparathyroidism) have considerable effects on patient quality of life. This Review highlights current debates, including undertaking active surveillance versus thyroid surgery for papillary thyroid microcarcinoma, the extent of thyroid surgery and lymphadenectomy for low-risk differentiated thyroid cancer, and the use of molecular testing to guide decision-making about whether surgery is required and the extent of the initial operation. This Review includes a discussion of current consensus guideline recommendations regarding these topics in patients with differentiated thyroid cancer. Additionally, innovative thyroidectomy techniques (including robotic and transoral approaches) are discussed, with an emphasis on patient preferences around decision-making and outcomes following thyroidectomy.

Author List

Wang TS, Sosa JA

Author

Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Biopsy, Fine-Needle
Carcinoma, Papillary
Disease-Free Survival
Female
Forecasting
Humans
Lymph Nodes
Male
Minimally Invasive Surgical Procedures
Neoplasm Invasiveness
Neoplasm Staging
Practice Guidelines as Topic
Prognosis
Quality Improvement
Risk Assessment
Robotics
Survival Analysis
Thyroid Gland
Thyroid Neoplasms
Thyroidectomy
Watchful Waiting