Recent Advances in the Surgical Management of Thyroid Cancer

Abstract

A growing incidence of differentiated thyroid cancer (DTC) has been reported in most developed countries, corresponding mainly to incidentally discovered small papillary thyroid carcinomas. Given the excellent prognosis of most patients with DTC, optimal therapeutic management, minimizing complications, and preserving patient quality of life are essential. Thyroid surgery has a central role in both the diagnosis, staging, and treatment of patients with DTC. Thyroid surgery should be integrated into the global and multidisciplinary management of patients with DTC. However, the optimal surgical management of DTC patients is still controversial. In this review article, we discuss the recent advances and current debates in DTC surgery, including preoperative molecular testing, risk stratification, the extent of thyroid surgery, innovative surgical tools, and new surgical approaches.

Keywords: papillary thyroid carcinoma; surgery; thyroid cancer.

Figure 1

Design of skin incisions in various types of robotic/endoscopic thyroidectomies. (A) – Cervical approach with CO₂ insufflation; – Minimally invasive video-assisted thyroidectomy; – Anterior chest approach with CO₂ insufflation; – Video-assisted neck surgery; (B) – Postauricular facelift approach; (C) – Transoral sublingual and vestibular approach with CO₂ insufflation; – Transoral vestibular approach with CO₂ insufflation; (D) – Bilateral axillo-breast approach with CO₂ insufflation; – Axillo-bilateral breast approach with CO₂ insufflation; – Breast approach with CO₂ insufflation; (E) – Axillary approach with CO₂ insufflation; – Unilateral axillo-breast approach with CO₂ insufflation; – Gasless unilateral axillary approach; – Single-incision transaxillary approach; – Gasless unilateral axillo-breast approach; – Gasless transaxillary approach with anterior chest port.