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Thyroid Cancer Surgery

  • Brian R. Untch
  • Dipti Kamani
  • Gregory W. RandolphEmail author
Chapter

Abstract

Surgery remains the most important treatment modality for most types of thyroid cancer. Thyroid cancers have a remarkable spectrum of clinical behavior; well-differentiated subtypes have excellent 10-year survival rates after surgery in contrast to anaplastic thyroid cancer, which is highly lethal even with aggressive treatment. The extent of thyroidectomy and lymph node dissection should be guided by cancer subtype, preoperative workup including imaging, and disease extent. Thyroidectomy should be carried out in a stepwise fashion with the goal of removing the gland and the cancer while limiting the risk of injury to the recurrent laryngeal nerve (RLN) and parathyroid glands. The surgeon should be vigilant in identifying RLN anatomy variability, and using intraoperative nerve monitor (IONM) can be a helpful adjunct to the surgeon, particularly in complex dissections. Critical to postoperative management is the recognition and treatment of complications from thyroidectomy and lymph node dissection. Surgery for recurrent thyroid cancer can be challenging, but good surgical and oncologic outcomes can be achieved with optimal surgical planning.

Keywords

Thyroid cancer Papillary thyroid carcinoma Follicular thyroid carcinoma Hurthle cell carcinoma Anaplastic thyroid carcinoma Poorly differentiated thyroid carcinoma Microcarcinoma Laryngoscopy Thyroidectomy Neck dissection Recurrent laryngeal nerve Intraoperative neuromonitoring (IONM) 

References

  1. 1.
    Grebe SK, Hay ID. Follicular thyroid cancer. Endocrinol Metab Clin North Am. 1995;24:761–801.CrossRefGoogle Scholar
  2. 2.
    Ganly I, Ricarte Filho J, Eng S, et al. Genomic dissection of Hurthle cell carcinoma reveals a unique class of thyroid malignancy. J Clin Endocrinol Metab. 2013;98:E962–72.CrossRefGoogle Scholar
  3. 3.
    Ibrahimpasic T, Ghossein R, Carlson DL, et al. Outcomes in patients with poorly differentiated thyroid carcinoma. J Clin Endocrinol Metab. 2014;99:1245–52.CrossRefGoogle Scholar
  4. 4.
    Ito K, Hanamura T, Murayama K, et al. Multimodality therapeutic outcomes in anaplastic thyroid carcinoma: improved survival in subgroups of patients with localized primary tumors. Head Neck. 2012;34:230–7.CrossRefGoogle Scholar
  5. 5.
    Volante M, Landolfi S, Chiusa L, et al. Poorly differentiated carcinomas of the thyroid with trabecular, insular, and solid patterns: a clinicopathologic study of 183 patients. Cancer. 2004;100:950–7.CrossRefGoogle Scholar
  6. 6.
    Carcangiu ML, Steeper T, Zampi G, et al. Anaplastic thyroid carcinoma. A study of 70 cases. Am J Clin Pathol. 1985;83:135–58.CrossRefGoogle Scholar
  7. 7.
    Davies L, Welch HG. Increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA. 2006;295:2164–7.CrossRefGoogle Scholar
  8. 8.
    Wells SA Jr, Asa SL, Dralle H, et al. Revised American Thyroid Association guidelines for the management of medullary thyroid carcinoma. Thyroid. 2015;25:567–610.CrossRefGoogle Scholar
  9. 9.
    Dottorini ME, Assi A, Sironi M, et al. Multivariate analysis of patients with medullary thyroid carcinoma. Prognostic significance and impact on treatment of clinical and pathologic variables. Cancer. 1996;77:1556–65.CrossRefGoogle Scholar
  10. 10.
    Machens A, Hauptmann S, Dralle H. Medullary thyroid cancer responsiveness to pentagastrin stimulation: an early surrogate parameter of tumor dissemination? J Clin Endocrinol Metab. 2008;93:2234–8.CrossRefGoogle Scholar
  11. 11.
    Vaccarella S, Franceschi S, Bray F, et al. Worldwide thyroid-cancer epidemic? The increasing impact of overdiagnosis. N Engl J Med. 2016;375:614–7.CrossRefGoogle Scholar
  12. 12.
    Davies L, Welch HG. Current thyroid cancer trends in the United States. JAMA Otolaryngol Head Neck Surg. 2014;140:317–22.CrossRefGoogle Scholar
  13. 13.
    Ito Y, Miyauchi A, Kihara M, et al. Patient age is significantly related to the progression of papillary microcarcinoma of the thyroid under observation. Thyroid. 2014;24:27–34.CrossRefGoogle Scholar
  14. 14.
    Brito JP, Ito Y, Miyauchi A, et al. A clinical framework to facilitate risk stratification when considering an active surveillance alternative to immediate biopsy and surgery in papillary microcarcinoma. Thyroid. 2016;26:144–9.CrossRefGoogle Scholar
  15. 15.
    Chandrasekhar SRG, Seidman MS, Rosenfeld R, Angelos P, Barkmeier-Kraemer J, Benninger MS, Blumin J, Dennis G, Hanks J, Haymart M, Kloos RT, Seals B, Schreibstein JM, Thomas TM, Waddington C, Warren B, Robertson PJ. American Academy of Otolaryngology Head and Neck Surgery clinical practice guidelines: improving voice outcomes after thyroid surgery. Otolaryngol Head Neck Surg. 2013;148(6 Suppl):S1–S37.CrossRefGoogle Scholar
  16. 16.
    Carneiro-Pla D, Solorzano CC, Wilhelm SM. Impact of vocal cord ultrasonography on endocrine surgery practices. Surgery. 2016;159:58–63.CrossRefGoogle Scholar
  17. 17.
    Carneiro-Pla D, Miller BS, Wilhelm SM, et al. Feasibility of surgeon-performed transcutaneous vocal cord ultrasonography in identifying vocal cord mobility: a multi-institutional experience. Surgery. 2014;156:1597–602. discussion 602–4.CrossRefGoogle Scholar
  18. 18.
    Lesnik D, Cunnane ME, Zurakowski D, et al. Papillary thyroid carcinoma nodal surgery directed by a preoperative radiographic map utilizing CT scan and ultrasound in all primary and reoperative patients. Head Neck. 2014;36:191–202.CrossRefGoogle Scholar
  19. 19.
    Fagin JA, Wells SA Jr. Biologic and clinical perspectives on thyroid cancer. N Engl J Med. 2016;375:1054–67.CrossRefGoogle Scholar
  20. 20.
    Bilimoria KY, Bentrem DJ, Ko CY, et al. Extent of surgery affects survival for papillary thyroid cancer. Ann Surg. 2007;246:375–81. discussion 81–4.CrossRefGoogle Scholar
  21. 21.
    Nixon IJ, Ganly I, Patel SG, et al. Thyroid lobectomy for treatment of well differentiated intrathyroid malignancy. Surgery. 2012;151:571–9.CrossRefGoogle Scholar
  22. 22.
    Haugen BR, Alexander EK, Bible KC, et al. 2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the american thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid. 2016;26:1–133.CrossRefGoogle Scholar
  23. 23.
    Dralle H, Sekulla C, Lorenz K, et al. Intraoperative monitoring of the recurrent laryngeal nerve in thyroid surgery. World J Surg. 2008;32:1358–66.CrossRefGoogle Scholar
  24. 24.
    Roy M, Rajamanickam V, Chen H, et al. Is DVT prophylaxis necessary for thyroidectomy and parathyroidectomy? Surgery. 2010;148:1163–8. discussion 68–9.CrossRefGoogle Scholar
  25. 25.
    Henry LR, Solomon NP, Howard R, et al. The functional impact on voice of sternothyroid muscle division during thyroidectomy. Ann Surg Oncol. 2008;15:2027–33.CrossRefGoogle Scholar
  26. 26.
    Hughes DT, White ML, Miller BS, et al. Influence of prophylactic central lymph node dissection on postoperative thyroglobulin levels and radioiodine treatment in papillary thyroid cancer. Surgery. 2010;148:1100–6. discussion 006–7.CrossRefGoogle Scholar
  27. 27.
    Hughes DT, Doherty GM. Central neck dissection for papillary thyroid cancer. Cancer Control. 2011;18:83–8.CrossRefGoogle Scholar
  28. 28.
    Mazzaferri EL, Doherty GM, Steward DL. The pros and cons of prophylactic central compartment lymph node dissection for papillary thyroid carcinoma. Thyroid. 2009;19:683–9.CrossRefGoogle Scholar
  29. 29.
    Gyorki DE, Untch B, Tuttle RM, et al. Prophylactic central neck dissection in differentiated thyroid cancer: an assessment of the evidence. Ann Surg Oncol. 2013;20:2285–9.CrossRefGoogle Scholar
  30. 30.
    Carling T, Carty SE, Ciarleglio MM, et al. American Thyroid Association design and feasibility of a prospective randomized controlled trial of prophylactic central lymph node dissection for papillary thyroid carcinoma. Thyroid. 2012;22:237–44.CrossRefGoogle Scholar
  31. 31.
    Randolph GW, Duh QY, Heller KS, et al. The prognostic significance of nodal metastases from papillary thyroid carcinoma can be stratified based on the size and number of metastatic lymph nodes, as well as the presence of extranodal extension. Thyroid. 2012;22:1144–52.CrossRefGoogle Scholar
  32. 32.
    Shen WT, Ogawa L, Ruan D, et al. Central neck lymph node dissection for papillary thyroid cancer: comparison of complication and recurrence rates in 295 initial dissections and reoperations. Arch Surg. 2010;145:272–5.CrossRefGoogle Scholar
  33. 33.
    Randolph GW, Dralle H, Abdullah H, et al. Electrophysiologic recurrent laryngeal nerve monitoring during thyroid and parathyroid surgery: International Standards Guideline Statement. Laryngoscope. 2011;121(Suppl 1):S1–16.CrossRefGoogle Scholar
  34. 34.
    Kandil E, Mohamed SE, Deniwar A, et al. Electrophysiologic identification and monitoring of the external branch of superior laryngeal nerve during thyroidectomy. Laryngoscope. 2015;125:1996–2000.CrossRefGoogle Scholar
  35. 35.
    Jatzko GR, Lisborg PH, Muller MG, et al. Recurrent nerve palsy after thyroid operations—principal nerve identification and a literature review. Surgery. 1994;115:139–44.PubMedGoogle Scholar
  36. 36.
    Henry JF, Audiffret J, Denizot A, et al. The nonrecurrent inferior laryngeal nerve: review of 33 cases, including two on the left side. Surgery. 1988;104:977–84.PubMedGoogle Scholar
  37. 37.
    Kamani D, Potenza AS, Cernea CR, et al. The nonrecurrent laryngeal nerve: anatomic and electrophysiologic algorithm for reliable identification. Laryngoscope. 2015;125:503–8.CrossRefGoogle Scholar
  38. 38.
    Mattsson P, Hydman J, Svensson M. Recovery of laryngeal function after intraoperative injury to the recurrent laryngeal nerve. Gland Surg. 2015;4:27–35.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Barczynski M, Randolph GW, Cernea CR, et al. External branch of the superior laryngeal nerve monitoring during thyroid and parathyroid surgery: International Neural Monitoring Study Group standards guideline statement. Laryngoscope. 2013;123(Suppl 4):S1–14.CrossRefGoogle Scholar
  40. 40.
    Lennquist S, Cahlin C, Smeds S. The superior laryngeal nerve in thyroid surgery. Surgery. 1987;102:999–1008.PubMedGoogle Scholar
  41. 41.
    Orestes MI, Chhetri DK. Superior laryngeal nerve injury: effects, clinical findings, prognosis, and management options. Curr Opin Otolaryngol Head Neck Surg. 2014;22:439–43.CrossRefGoogle Scholar
  42. 42.
    Morton RP, Whitfield P, Al-Ali S. Anatomical and surgical considerations of the external branch of the superior laryngeal nerve: a systematic review. (Erratum appears in Clin Otolaryngol. 2007;32(1):78). Clin Otolaryngol. 2006;31:368–74.CrossRefGoogle Scholar
  43. 43.
    Chuang YC, Huang SM. Protective effect of intraoperative nerve monitoring against recurrent laryngeal nerve injury during re-exploration of the thyroid. World J Surg Oncol. 2013;11:94.CrossRefGoogle Scholar
  44. 44.
    Chan WF, Lang BH, Lo CY. The role of intraoperative neuromonitoring of recurrent laryngeal nerve during thyroidectomy: a comparative study on 1000 nerves at risk. Surgery. 2006;140:866–72. discussion 72–3.CrossRefGoogle Scholar
  45. 45.
    Phelan E, Kamani D, Shin J, et al. Neural monitored revision thyroid cancer surgery: surgical safety and thyroglobulin response. Otolaryngol Head Neck Surg. 2013;149:47–52.CrossRefGoogle Scholar
  46. 46.
    Salari B, Ren Y, Kamani D, et al. Revision neural monitored surgery for recurrent thyroid cancer: safety and thyroglobulin response. Laryngoscope. 2016;126:1020–5.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Brian R. Untch
    • 1
  • Dipti Kamani
    • 2
  • Gregory W. Randolph
    • 2
    • 3
    Email author
  1. 1.Department of OtolaryngologyIcahn School of Medicine at Mount SinaiNew YorkUSA
  2. 2.Division of Thyroid and Parathyroid Endocrine Surgery, Department of Otolaryngology—Head and Neck SurgeryMassachusetts Eye and Ear Infirmary, Harvard Medical SchoolBostonUSA
  3. 3.Department of SurgeryEndocrine Surgery Service, Massachusetts General Hospital, Harvard Medical SchoolBostonUSA

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