Controversies in the surgical management of differentiated thyroid carcinoma

We reviewed the literature related to the surgical management of differentiated thyroid carcinoma (DTC), and examined ongoing controversies regarding treatment. DTC has a relatively indolent biologic behavior, but it tends to spread to the thyroid and/or regional lymph nodes even in the early stages of the disease. On the other hand, surgical resection is the most effective treatment for DTC, but the extent of surgical resection has been controversial. The impact of surgery has been considered to be only minor in the prognosis of the majority of patients, unless grossly malignant residue is left behind. Nevertheless, in some patients the disease follows an aggressive course culminating in death. For such high-risk patients, a more extensive operation should be performed. Therefore, it may be concluded that the extent of surgical resection should depend on the basis of the biologic behavior of the DTC rather than the extent of cancer involvement in the thyroid and regional lymph nodes.