Which surgery needs to be used in the Differentiated Thyroid Carcinoma?

Surgery for thyroid carcinoma involves a complex decision-making process and technical skills, both related to the experience of the endocrinologist and surgeon. Based on a stratified risk approach for the management of differentiated thyroid carcinoma, therapeutic decisions can now be divided into active surveillance or immediate surgery, e.g. hemithyroidectomy with isthmectomy, total thyroidectomy, or thyroidectomy and locoregional lymphadenectomy. Total thyroidectomy is a surgery associated with high rates of healing and has been considered the gold standard for years. However, thyroid lobectomy, in selected cases, is now recognized as equally oncologically effective and is associated with decreased morbidity in appropriately selected patients. The morbidity of the prophylactic lymphadenectomy of the central compartment is significant in terms of transient and permanent hypocalcaemia. This led to a less aggressive prophylactic surgical approach in the recent guidelines of the American Thyroid Association of 2015. Re-operations in the central or lateral compartment can be difficult and lead to an increased risk to the patient. Therefore, it is important to perform an optimal initial operation in every patient with thyroid cancer. Consideration should be given to addressing patients with high-risk characteristics (N1 clinical disease, locally invasive disease) to experienced surgeons, both for oncologic completeness and for significant impact on clinical outcomes and complication rates.