Surgical management of locally advanced thyroid cancer

To summarize recent literature with respect to locally invasive thyroid cancer and discuss the variety of surgical management techniques according to the sites involved.

Different philosophies for surgical strategy in patients with locally invasive thyroid cancer still exist. Intraoperative neuromonitoring assessment of the functional status of the recurrent laryngeal nerve is helpful to decide surgical extent. A staging system based on the degree of invasion has been suggested for the proper management of laryngotracheal invasion.

The goal of treatment of locally invasive thyroid cancer is to maximize local control and overall survival while minimizing the morbidity of a radical resection or preserving function of adjacent vital structures with conservative procedures. It is imperative that the operating surgeon be familiar with an algorithm for the appropriate workup and surgical planning. In addition, various factors such as the patient's age, tumor biology and histopathology, previous response to treatment, presence of distant metastasis, or adjuvant therapy can affect the extent of surgical resection.