Langenbeck's Archives of Surgery

, Volume 398, Issue 3, pp 347–375 | Cite as

German Association of Endocrine Surgeons practice guideline for the surgical management of malignant thyroid tumors

  • Henning DralleEmail author
  • Thomas J. Musholt
  • Jochen Schabram
  • Thomas Steinmüller
  • Andreja Frilling
  • Dietmar Simon
  • Peter E. Goretzki
  • Bruno Niederle
  • Christian Scheuba
  • Thomas Clerici
  • Michael Hermann
  • Jochen Kußmann
  • Kerstin Lorenz
  • Christoph Nies
  • Peter Schabram
  • Arnold Trupka
  • Andreas Zielke
  • Wolfram Karges
  • Markus Luster
  • Kurt W. Schmid
  • Dirk Vordermark
  • Hans-Joachim Schmoll
  • Reinhard Mühlenberg
  • Otmar Schober
  • Harald Rimmele
  • Andreas Machens
  • for the German Societies of General and Visceral Surgery; Endocrinology; Nuclear Medicine; Pathology; Radiooncology; Oncological Hematology; and the German Thyroid Cancer Patient Support Organization Ohne Schilddrüse leben e.V.
Review Article



Over the past years, the incidence of thyroid cancer has surged not only in Germany but also in other countries of the Western hemisphere. This surge was first and foremost due to an increase of prognostically favorable (“low risk”) papillary thyroid microcarcinomas, for which limited surgical procedures are often sufficient without loss of oncological benefit. These developments called for an update of the previous practice guideline to detail the surgical treatment options that are available for the various disease entities and tumor stages.


The present German Association of Endocrine Surgeons practice guideline was developed on the basis of clinical evidence considering current national and international treatment recommendations through a formal expert consensus process in collaboration with the German Societies of General and Visceral Surgery, Endocrinology, Nuclear Medicine, Pathology, Radiooncology, Oncological Hematology, and a German thyroid cancer patient support organization.


The practice guideline for the surgical management of malignant thyroid tumors includes recommendations regarding preoperative workup; classification of locoregional nodes and terminology of surgical procedures; frequency, clinical, and histopathological features of occult and clinically apparent papillary, follicular, poorly differentiated, undifferentiated, and sporadic and hereditary medullary thyroid cancers, thyroid lymphoma and thyroid metastases from primaries outside the thyroid gland; extent of thyroidectomy; extent of lymph node dissection; aerodigestive tract resection; postoperative follow-up and surgery for recurrence and distant metastases.


These evidence-based recommendations for surgical therapy reflect various “treatment corridors” that are best discussed within multidisciplinary teams and the patient considering tumor type, stage, progression, and inherent surgical risk.


Lymph node classification Compartment-oriented surgery Papillary, follicular, and medullary thyroid carcinoma Poorly differentiated and undifferentiated carcinoma Thyroid lymphoma Thyroid metastases from renal cell, lung, and breast cancer 


Conflicts of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Henning Dralle
    • 1
    Email author
  • Thomas J. Musholt
    • 2
  • Jochen Schabram
    • 3
  • Thomas Steinmüller
    • 4
  • Andreja Frilling
    • 5
  • Dietmar Simon
    • 6
  • Peter E. Goretzki
    • 7
  • Bruno Niederle
    • 8
  • Christian Scheuba
    • 8
  • Thomas Clerici
    • 9
  • Michael Hermann
    • 10
  • Jochen Kußmann
    • 11
  • Kerstin Lorenz
    • 1
  • Christoph Nies
    • 12
  • Peter Schabram
    • 13
  • Arnold Trupka
    • 14
  • Andreas Zielke
    • 15
  • Wolfram Karges
    • 16
  • Markus Luster
    • 17
  • Kurt W. Schmid
    • 18
  • Dirk Vordermark
    • 19
  • Hans-Joachim Schmoll
    • 20
  • Reinhard Mühlenberg
    • 21
  • Otmar Schober
    • 22
  • Harald Rimmele
    • 23
  • Andreas Machens
    • 1
  • for the German Societies of General and Visceral Surgery; Endocrinology; Nuclear Medicine; Pathology; Radiooncology; Oncological Hematology; and the German Thyroid Cancer Patient Support Organization Ohne Schilddrüse leben e.V.
  1. 1.Department of General, Visceral and Vascular SurgeryMartin Luther University Halle-WittenbergHalle (Saale)Germany
  2. 2.Department of General and Abdominal SurgeryGutenberg UniversityMainzGermany
  3. 3.Department of SurgerySt. Josefs Krankenhaus GiessenGiessenGermany
  4. 4.Department of Visceral and Endocrine SurgeryDRK-Kliniken Berlin-WestendBerlinGermany
  5. 5.Department of Surgery and Cancer, Imperial College LondonHammersmith HospitalLondonUK
  6. 6.Department of General and Visceral SurgeryBethesda HospitalDuisburgGermany
  7. 7.Lukaskrankenhaus NeussNeussGermany
  8. 8.Department of SurgeryMedical University of ViennaViennaAustria
  9. 9.Department of SurgeryKantonsspital St. GallenSt. GallSwitzerland
  10. 10.Department of Surgery, Kaiser-Elisabeth-SpitalMedical University of ViennaViennaAustria
  11. 11.Clinic for Endocrine SurgerySchön Klinik Hamburg-EilbeckHamburgGermany
  12. 12.Department of General and Vascular Surgery, Niels-Stensen-KlinikenMarienhospital OsnabrückOsnabrückGermany
  13. 13.Ratajczak and PartnersFreiburgGermany
  14. 14.Department of SurgeryKreiskrankenhaus StarnbergStarnbergGermany
  15. 15.Department of SurgeryKlinikum OffenbachOffenbachGermany
  16. 16.Division of Endocrinology and DiabetesUniversitätsklinikum AachenAachenGermany
  17. 17.Department of Nuclear MedicineUniversitätsklinikum UlmUlmGermany
  18. 18.Department of PathologyUniversitätsklinikum EssenEssenGermany
  19. 19.Department of RadiooncologyUniversitätsklinikum HalleHalle/SaaleGermany
  20. 20.Department of HematooncologyUniversitätsklinikum HalleHalle/SaaleGermany
  21. 21.Department of PediatricsKlinikum KrefeldKrefeldGermany
  22. 22.Department of Nuclear MedicineUniversity Hospital Westfälische Wilhelms-UniversityMünsterGermany
  23. 23.German Thyroid Cancer Patient Support Organization, Ohne Schilddrüse leben e.V.–Bundesverband SchilddrüsenkrebsBerlinGermany

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