Papillary thyroid cancer: strategies for optimal individualized surgical management

The goal of this article was to describe the optimal individualized surgical management of patients with papillary thyroid cancer (PTC).

This summary reviews the relevant literature that takes into account description of the context of disease incidence, current practice guidelines, controversies in the management of thyroid resection and management of central neck lymph nodes, alternative methods of treatment, and evidence from the author's institution to support the final recommendations.

Combining the rationale for treatment decisions from the Mayo Clinic's surgical management of PTC, plus recently published large institutional series and a meta-analysis of patient outcomes, the recommendations for PTC >1 cm include the following: (1) preoperative ultrasound to identify and map the location of lateral jugular lymph node metastasis; (2) bilateral total or near-total thyroidectomy; (3) routine central neck (compartment VI) lymph node dissection; and (4) inclusion of lateral neck lymph node dissection when indicated. Alterations are advised depending on either the level of expertise or anatomic findings at the time of performing the thyroidectomy and lymph node dissection.

Because all of the data presented from the Mayo Clinic and the literature fall short of Level 1 evidence, these recommendations should not be considered dogmatic nor should they exclude reasonable alternatives that are also presented.