Annals of Otolaryngology Head and Neck Surgery (ISSN 2835-7132) | Volume 5, Issue 5 | Review Article | Open Access
Rodrigo Arrangoiz*
Rodrigo Arrangoiz1*, Susana Barreiro Sacco2, Aradhya Nigam3, Fernando Cordera4
1Division of Surgical Oncology at the Braman Comprehensive Cancer Center at Mount Sinai Medical Center, Florida
2Division of Endocrinology at the Braman Comprehensive Cancer Center at Mount Sinai Medical Center, Florida
3Division of Surgical Oncology at the Braman Comprehensive Cancer Center at Mount Sinai Medical Center, Florida
4Sociedad Quirurgica S.C. at the American British Cowdray Medical Center in Mexico City, Mexico
*Correspondence to: Rodrigo Arrangoiz
Fulltext PDFBackground: Locally advanced differentiated thyroid cancer presents significant challenges in diagnosis, surgical management, and multidisciplinary treatment, particularly when tumors invade critical structures such as the recurrent laryngeal nerve, trachea, larynx, esophagus, or major cervical vessels. Advances in molecular profiling, targeted systemic therapies, and surgical techniques have substantially expanded treatment options, creating opportunities to improve oncologic outcomes while preserving organ function and quality of life.
Methods: A comprehensive narrative review of the literature was conducted, focusing on contemporary evidence regarding the evaluation and management of locally advanced thyroid cancer. Relevant clinical studies, systematic reviews, consensus statements, and international guidelines were examined, with particular emphasis on the American Thyroid Association and National Comprehensive Cancer Network recommendations. The review evaluated prognostic factors, imaging modalities, molecular alterations, surgical approaches, neoadjuvant therapies, and multidisciplinary treatment strategies.
Results: The extent and anatomical location of gross extrathyroidal extension, completeness of surgical resection, histologic subtype, and molecular characteristics are major determinants of prognosis and treatment selection. Complete macroscopic resection remains a central therapeutic objective when technically feasible, although surgical aggressiveness must be balanced against functional morbidity. Advances in preoperative imaging and intraoperative techniques have improved surgical planning and the management of invasion involving the aerodigestive tract and recurrent laryngeal nerve. Molecularly targeted therapies, particularly inhibitors directed against BRAF, RET, and NTRK alterations, have demonstrated clinically meaningful responses in selected patients. Emerging evidence also supports the potential role of neoadjuvant systemic therapy in reducing tumor burden and facilitating resection of initially unresectable or borderline resectable disease, although long-term oncologic outcomes remain insufficiently established.
Conclusions: The management of locally advanced thyroid cancer has evolved from a predominantly surgery-centered approach toward an individualized, multidisciplinary strategy integrating anatomical assessment, molecular characterization, advanced surgical techniques, and selective systemic therapies. Achieving optimal oncologic control while preserving function requires careful patient selection and coordinated treatment planning. The incorporation of molecularly guided neoadjuvant therapy represents a promising development that may expand surgical opportunities in selected patients. Future prospective studies are essential to define optimal treatment sequencing, establish standardized selection criteria, and determine long-term survival and functional outcomes.
Locally advanced thyroid cancer; Extrathyroidal extension; Differentiated thyroid carcinoma; Surgical management; Recurrent laryngeal nerve invasion; Tracheal invasion; Molecular targeted therapy; Neoadjuvant therapy; Multidisciplinary management
Rodrigo Arrangoiz, Susana Barreiro Sacco, Aradhya Nigam, Fernando Cordera.Surgical Management of Locally Advanced Differentiated Thyroid Cancer: A Structure- and Depth-Based Review. Annals of Otolaryngology Head and Neck Surgery. 2026;5(5):1-63.