Lateral Neck Dissection for Well-Differentiated Thyroid Carcinoma: Is Prophylactic Level V Neck Dissection Necessary? A Retrospective Cohort Study

Techniques for Thyroidectomy and Functional Neck Dissection

Thyroidectomy is a commonly performed surgery for thyroid cancer, Graves' disease, and thyroid nodules. With the increasing incidence of thyroid cancer, understanding the anatomy and surgical techniques is crucial to ensure successful outcomes and minimize complications. This review discusses the anatomical considerations of the thyroid and neck, including lymphatic drainage and the structures at risk during thyroidectomy. Emphasis is placed on the significance of cautious dissection to preserve critical structures, such as the parathyroid glands and recurrent laryngeal nerve. Neck dissection is also explored, particularly in cases of lymph node metastasis, in which its proper execution is essential for better survival rates. Additionally, this review evaluates various thyroidectomy techniques, including minimally invasive approaches, highlighting their potential benefits and limitations. Continuous surgical knowledge and expertise updates are necessary to ensure the best results for patients undergoing thyroidectomy.

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

The aim of this study was to develop evidence-based recommendations for determining the surgical extent in patients with locally invasive differentiated thyroid cancer (DTC). Locally invasive DTC with gross extrathyroidal extension invading surrounding anatomical structures may lead to several functional deficits and poor oncological outcomes. At present, the optimal extent of surgery in locally invasive DTC remains a matter of debate, and there are no adequate guidelines. On October 8, 2021, four experts searched the PubMed, Embase, and Cochrane Library databases; the identified papers were reviewed by 39 experts in thyroid and head and neck surgery. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the quality of evidence, and to develop and report recommendations. The strength of a recommendation reflects the confidence of a guideline panel that the desirable effects of an intervention outweigh any undesirable effects, across all patients for whom the recommendation is applicable. After completing the 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; surgical extent 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-based guidelines were devised to help clinicians make safer and more efficient clinical decisions for the optimal surgical treatment of patients with locally invasive DTC.

Comparison of surgical outcomes between patients undergoing trans-oral endoscopic thyroid surgery combined with trans-thoracoareolar approach and conventional open surgery

Over the past decades, remote-access thyroid surgery has been widely developed in the treatment of thyroid carcinoma, which can help patients to avoid cosmetically displeasing scarring. In this research, we collected and review our experience with endoscopic thyroidectomy with neck dissection via trans-thoracoareolar approach combined with trans-oral approach over a 3-year period. They were all diagnosed with thyroid carcinoma, and two of them had a complication of Hashimoto's thyroiditis. No patients were dissatisfied with the postoperative cosmetic results. One patient had numbness in the lower lip, but the symptom disappeared 1 month later. No infection, hemorrhage, or air embolism occurred. Pain and numbness in the endoscopic thyroid surgery group were slighter than in those who had open surgery. The present study aims to compare the feasibility and safety of trans-thoracoareolar approach combined with trans-oral approach to conventional open surgery.