Guideline for the Surgical Management of Locally Invasive Differentiated Thyroid Cancer From the Korean Society of Head and Neck Surgery

초록

The aim of this study was to develop evidence-based recommendations for determining the surgical extent in patients withlocally invasive differentiated thyroid cancer (DTC). Locally invasive DTC with gross extrathyroidal extension invadingsurrounding anatomical structures may lead to several functional deficits and poor oncological outcomes. At present, theoptimal extent of surgery in locally invasive DTC remains a matter of debate, and there are no adequate guidelines. OnOctober 8, 2021, four experts searched the PubMed, Embase, and Cochrane Library databases; the identified papers werereviewed by 39 experts in thyroid and head and neck surgery. The Grading of Recommendations Assessment, Developmentand Evaluation (GRADE) approach was used to assess the quality of evidence, and to develop and report recommenda-tions. The strength of a recommendation reflects the confidence of a guideline panel that the desirable effects of an inter-vention outweigh any undesirable effects, across all patients for whom the recommendation is applicable. After completingthe draft guidelines, Delphi questionnaires were completed by members of the Korean Society of Head and Neck Surgery. Twenty-seven evidence-based recommendations were made for several factors, including the preoperative workup; surgicalextent of thyroidectomy; surgery for cancer invading the strap muscles, recurrent laryngeal nerve, laryngeal framework,trachea, or esophagus; and surgery for patients with central and lateral cervical lymph node involvement. Evidence-basedguidelines were devised to help clinicians make safer and more efficient clinical decisions for the optimal surgical treatmentof patients with locally invasive DTC.

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