Clin Exp Otorhinolaryngol.  2023 Feb;16(1):1-19. 10.21053/ceo.2022.01732.

Guideline for the Surgical Management of Locally Invasive Differentiated Thyroid Cancer From the Korean Society of Head and Neck Surgery

• Park JO
• Kim JH
• Joo YH
• Kim SY
• Kim GJ
• Kim HB
• Lee DH
• Hong HJ
• Park YM
• Chung EJ
• Ji YB
• Oh KH
• Lee HS
• Lee DK
• Park KN
• Ban MJ
• Kim BH
• Kim DH
• Cho JK
• Ahn DB
• Kim MS
• Seok JG
• Jang JY
• Choi HG
• Kim HJ
• Park SJ
• Jung EK
• Kim YS
• Hong YT
• Lee YC
• Won HR
• Shin SC
• Baek SK
• Kwon SY

• KMID: 2539764
• DOI: http://doi.org/10.21053/ceo.2022.01732

Abstract

The aim of this study was to develop evidence-based recommendations for determining the surgical extent in patients with locally invasive differentiated thyroid cancer (DTC). Locally invasive DTC with gross extrathyroidal extension invading surrounding anatomical structures may lead to several functional deficits and poor oncological outcomes. At present, the optimal extent of surgery in locally invasive DTC remains a matter of debate, and there are no adequate guidelines. On October 8, 2021, four experts searched the PubMed, Embase, and Cochrane Library databases; the identified papers were reviewed by 39 experts in thyroid and head and neck surgery. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence, and to develop and report recommendations. The strength of a recommendation reflects the confidence of a guideline panel that the desirable effects of an intervention outweigh any undesirable effects, across all patients for whom the recommendation is applicable. After completing the draft guidelines, Delphi questionnaires were completed by members of the Korean Society of Head and Neck Surgery. Twenty-seven evidence-based recommendations were made for several factors, including the preoperative workup; surgical extent of thyroidectomy; surgery for cancer invading the strap muscles, recurrent laryngeal nerve, laryngeal framework, trachea, or esophagus; and surgery for patients with central and lateral cervical lymph node involvement. Evidence-based guidelines were devised to help clinicians make safer and more efficient clinical decisions for the optimal surgical treatment of patients with locally invasive DTC.

Keyword

Guidelines; Thyroidectomy; Recurrent Laryngeal Nerve; Trachea; Lymph Nodes; Esophagus

Figure

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  Fig. 1. Critical anatomical structures adjacent to the thyroid gland: trachea, larynx, esophagus, and recurrent laryngeal nerve.

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