J.Jpn. Surg. Soc.. 124(1): 44-49, 2023

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APPROACHES TO LOCALLY ADVANCED DIFFERENTIATED THYROID CARCINOMA

Although differentiated thyroid carcinoma (DTC) generally has an excellent prognosis, the rare invasions of the upper aerodigestive tract by DTC have negative impacts on prognosis and quality of life. Patients with intraluminal extension to the aerodigestive tract have a worse prognosis than those with superficial invasion. Although the surgical management of airway invasion remains controversial, there is no consensus regarding whether surgical management should be used in patients with superficial invasion of the aerodigestive tract. However, function-preserving surgery including shave excision for tracheal invasion is often performed for superficial aerodigestive tract invasion. Unlike the Western standard of total thyroidectomy for DTC, Japanese thyroid surgery has evolved in a unique way, focusing on function-preserving surgery. This is also true for the treatment of locally advanced cancer. In particular, RLN resection and immediate RLN reconstruction for patients with RLN invasion or two-stage phonetic surgery (thyroplasty) for patients with RLN resection without immediate nerve reconstruction were shown effective in improving vocal function in multiple reports from Japan and have been performed worldwide. We report on the treatment efforts and results of endocrine surgeons and head and neck surgeons in Japan.

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