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Therapeutic Strategy for Differentiated Thyroid Carcinoma in Japan Based on a Newly Established Guideline Managed by Japanese Society of Thyroid Surgeons and Japanese Association of Endocrine Surgeons

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Abstract

Background

Therapeutic strategy for patients with differentiated thyroid carcinoma (DTC) in Japan has differed from that in Western countries. Total thyroidectomy followed by radioactive iodine (RAI) ablation has been a standard therapy in Western countries, while limited thyroidectomy has been widely accepted in Japan. We newly established guidelines for clinical practice in treating thyroid tumors based on evidence from previous publications and the accumulation of data from patients in Japan. We present our therapeutic recommendations for DTC patients based on these guidelines.

Methods

From the 55 clinical questions (CQ) in our guideline, we selected CQ regarding the treatment of DTC. We commented on each and compared it with the corresponding regions in Western guidelines.

Results

For papillary carcinoma, we strongly or moderately recommend total thyroidectomy for patients with tumors larger than 4 cm, clinical node metastasis, distant metastasis, or significant extrathyroid extension, while hemithyroidectomy is acceptable for T1N0M0 patients. In contrast to Western guidelines, routine central compartment dissection is recommended for papillary carcinoma in our guidelines. Completion total thyroidectomy is recommended for patients who were scheduled for hemithyroidectomy under a preoperative diagnosis of follicular neoplasm and were pathologically confirmed as having follicular carcinoma if the pathological diagnosis indicated widely invasive carcinoma or carcinoma having poorly differentiated components. RAI ablation is also recommended for DTC with aggressive clinicopathological features, but its indication is narrower than that in Western guidelines, not only because of the limitations on RAI, but also because it is our policy that patients without high-risk features do not require RAI ablation.

Conclusion

It is important to treat DTC patients individually according to their clinicopathological features rather than uniformly. We hope that policies regarding the treatment of DTC patients in Western countries and Japan will find the optimal compromise in the future, leading to the best treatments for patients with thyroid carcinoma all over the world.

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Acknowledgment

The authors thank other members of the task force on the guidelines for management of thyroid tumor: Drs. Haruki Akasu (Department of Surgery, Division of Endocrine Surgery, Nippon Medical School), Minoru Fujimiori (Department of Breast Surgery, Tokyo Medical University, Ibaraki Medical Center), Hisato Hara (Department of Breast and Endocrine Surgery, Clinical Science, Graduate School of Comprehensive Human Sciences, University of Tsukuba), Yatsuka Hibi (Department of Endocrine Surgery, Fujita Health University School of Medicine), Tatsuya Higashi (Shiga Medical Center Research Institute), Takehito Igarashi (Department of Surgery, Division of Endocrine Surgery, Nippon Medical School), Tsuneo Imai (Department of Breast and Endocrine Surgery, Nagoya University), Hiroyuki Iwasaki (Department of Surgery, Atami Hospital, International University of Health and Welfare), Kaori Kameyama (Department of Diagnostic Pathology, Keio University School of Medicine), Hiroshi Kanma (Department of Pathology, Kyorin University School of Medicine), Seigo Kinuya (Department of Nuclear Medicine, Faculty of Medicine, Institute of Medical Pharmaceutical and Health Sciences, Kanazawa University), Wataru Kitagawa (Department of Surgery, Ito Hospital), Hiroya Kitano (Division of Otolaryngology, Head & Neck Surgery, Department of Sensory and Motor Organ, Faculty of Medicine, Tottori University), Kaoru Kobayashi (Departnent of Suregery Kuma Hospital), Daishu Miura (Department of Breast and Endocrine Surgery, Toranomon Hospital), Megumi Miyakawa (Endocrine Center, Toranomon Hospital), Yasushi Noguchi (Department of Radiology, Noguchi Thyroid Clinic and Hospital Foundation), Naoyoshi Onoda (Department of Surgical Oncology, Osaka City University Graduate School of Medicine), Masahisa Saikawa (Division of Head and Neck Surgery, National Center Hospital East), Naoyuki Shigematsu (Department of Radiology, Keio University School of Medicine), Kiminori Sugino (Department of Surgery, Ito Hospital), Iwao Sugitani (Division of Head and Neck, Cancer Institute Hospital, Japanese Foundation for Cancer Research), Shinichi Suzuki (Department of Organ Regulation Surgery, Fukushima Medical University School of Medicine), Katsuhiro Tanaka (Department of Breast and Thyroid Surgery, Kawasaki Medical School), Hidemitsu Tsutsui (Department of Thoracic and Thyroid Surgery, Tokyo Medical University), Shinya Uchino (Department of Surgery, Noguchi Thyroid Clinic and Hospital Foundation), and Nobuyuki Wada (Department of Surgery, Yokohama City University). The task force thanks Ms. Fujimi Kawai (Medical Library, St. Luka’s International Hospital) and Dr. Masahiro Yoshida (International University of Health and Welfare) for their constant help and support.

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Authors and Affiliations

  1. Department of Surgery, Teikyo University School of Medicine, Tokyo, 173-8605, Japan

    Hiroshi Takami

  2. Department of Surgery, Kuma Hospital, 8-2-35, Shimoyamate-dori, Chuo-ku, Kobe, 650-0011, Japan

    Yasuhiro Ito

  3. Department of Endocrine Surgery and Hygiene and Public Health II, Tokyo Women’s Medical University, Tokyo, Japan

    Takahiro Okamoto

  4. Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, Kanagawa, Japan

    Akira Yoshida

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  1. Hiroshi Takami
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  2. Yasuhiro Ito
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  3. Takahiro Okamoto
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  4. Akira Yoshida
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Correspondence to Yasuhiro Ito.

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Takami, H., Ito, Y., Okamoto, T. et al. Therapeutic Strategy for Differentiated Thyroid Carcinoma in Japan Based on a Newly Established Guideline Managed by Japanese Society of Thyroid Surgeons and Japanese Association of Endocrine Surgeons. World J Surg 35, 111–121 (2011). https://doi.org/10.1007/s00268-010-0832-6

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