Consensus conference on well-differentiated thyroid cancer: a summary.

OBJECTIVE: To update recommendations for the surgical treatment of well-differentiated thyroid cancer.

DATA SOURCES: Literature reviews and personal files.

STUDY SELECTION: Panelists selected relevant articles to make arguments for and against current recommendations for the surgical treatment of well-differentiated thyroid cancer.

OUTCOMES: Four aspects of surgical treatment were considered: (a) the extent of surgical resection, (b) the definition and utilization of high- and low-risk patient groups, (c) who should perform thyroid surgery and (d) the use of radioactive iodine.

RECOMMENDATIONS: Total thyroidectomy is not the treatment of choice for all well-differentiated thyroid cancers. The use of risk factors help select those patients in whom a total thyroidectomy would be of benefit. High-risk patients are those who are considered at high risk according to the AGES and AMES classifications or who have lymph-node metastases, aggressive variants of their disease, multifocal cancer or disease in the contralateral thyroid lobe and a history of radiation to the neck. Those at low-risk are those previously described as being at low risk according to the AGES and AMES classifications. General surgery training programs across Canada need to ensure that their residents obtain enough experience in thyroid surgery that as general surgeons they can perform this type of surgery with low morbidity.

CONCLUSIONS: The findings of this consensus conference were supported by those of several review articles and by the arguments put forward by the panelists. These findings are only guidelines as to the surgical approach to well-differentiated thyroid cancer.