Abstract
Thyroid cancer is the most common malignancy of the endocrine system and its incidence has dramatically increased over the past three decades. Well-differentiated thyroid cancers (DTCs) are the main focus of this article, as they represent >90% of thyroid malignancies. This Review provides an overview of the controversies surrounding the optimal choice of surgery and extent of resection for patients with low-risk DTC or with papillary thyroid microcarcinoma, and the role of prophylactic central lymph node dissection. This Review also outlines the current surgical management of DTC and presents updated results for these techniques, along with important advances and current dilemmas in surgical approaches to treatment of these cancers. For example, endoscopic and robotic thyroidectomy are the two most recent innovations to present technical and other challenges to the endocrine surgeon; in addition, the risks as well as the advantages of same-day thyroid surgery, which has gained some acceptance, are detailed. Arguments for and against each approach are presented, along with supporting evidence. The authors' personal opinions are also provided for each topic.
Key Points
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Thyroid cancer is the most common malignancy of the endocrine system and its incidence is increasing
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The optimal therapy for papillary thyroid microcarcinoma is currently unclear, and is a controversial issue; suggested management strategies range from regular observation to total thyroidectomy
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Prophylactic central lymph node dissection might identify high rates of lymph node involvement without providing long-term benefits; therefore, its routine use is currently unwarranted
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Same-day thyroid surgery is gaining acceptance and can be safely performed in the majority of patients as long as an appropriate support system is present
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Change history
06 December 2011
At the end of the second paragraph of the section 'Papillary thyroid microcarcinoma', it should read “In one study, tumor growth of 2 mm was detected in 30% of patients who underwent observation alone. More than one-third (56 of 162) of all patients assigned to observation underwent surgery after 19–56 months of observation, although for 47 of them this decision was not necessarily related to tumor progression. Lymph-node metastases were suspected by ultrasonography at the beginning of the study or during follow-up in 12.3% of all patients who underwent observation.” The error has been corrected for the HTML and PDF versions of the article.
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H. Mazeh researched the data for the article. Both authors wrote the article, and provided substantial contributions to discussions of the content, as well as to review and/or editing of the manuscript before submission.
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Mazeh, H., Chen, H. Advances in surgical therapy for thyroid cancer. Nat Rev Endocrinol 7, 581–588 (2011). https://doi.org/10.1038/nrendo.2011.140
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DOI: https://doi.org/10.1038/nrendo.2011.140
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