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

Affiliations
  • 1Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 2Department of Otolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Korea
  • 3Department of Otolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
  • 4Department of Otolaryngology-Head and Neck Surgery, Hanyang University College of Medicine, Seoul, Korea
  • 5Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
  • 6Department of Otolaryngology-Head and Neck Surgery, Kosin University College of Medicine, Busan, Korea
  • 7Department of Otolaryngology-Head and Neck Surgery, Dong-A University College of Medicine, Busan, Korea
  • 8Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Asan, Korea
  • 9Department of Otolaryngology-Head and Neck Surgery, Dongguk University College of Medicine, Goyang, Korea
  • 10Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Inje University, Busan, Korea
  • 11Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, Korea
  • 12Department of Otolaryngology-Head and Neck Surgery, CHA University School of Medicine, Seongnam, Korea
  • 13Department of Otolaryngology-Head and Neck Surgery, National Cancer Center, Goyang, Korea
  • 14Department of Otolaryngology-Head and Neck Surgery, Ajou University School of Medicine, Suwon, Korea
  • 15Department of Otolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Korea
  • 16Department of Otolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
  • 17Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School, Kwangju, Korea
  • 18Department of Otolaryngology-Head and Neck Surgery, Konyang University College of Medicine, Daejeon, Korea
  • 19Department of Otolaryngology-Head and Neck Surgery, Jeonbuk National University Medical School, Jeonju, Korea
  • 20Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
  • 21Department of Otolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Korea
  • 22Department of Otolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Yangsan, Korea

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

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


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