Surgical management of papillary thyroid cancer: review of current evidence and consensus

The optimal surgical management of papillary thyroid carcinoma has been an ongoing debate. Most recommendations in clinical practice guidelines are based on large retrospective studies and expert opinion. The objective of the article is to summarize the recent evidence and main arguments related to the surgical management of papillary thyroid carcinoma. A definitive correlation between loco-regional recurrence and long-term survival and the extent of thyroid resection or lymph node dissection have not been established through randomized controlled clinical trials. Due to the low rates of recurrence and mortality associated with papillary thyroid cancer, large scale prospective randomized controlled trials that will help identify the optimal surgical management are unlikely to be available in the future as well. According to current consensus, hemithyroidectomy is sufficient for low-risk disease whereas total thyroidectomy should be performed in those with high-risk features. The place of therapeutic and prophylactic central compartment and lateral neck dissection is discussed based on evidence on short-term and long term outcomes. Furthermore, post-operative staging and dynamic risk stratification are important in determining adjuvant therapy and a follow-up plan.