[Current practice in treatment of differentiated thyroid cancer in Japan in comparison with the guidelines in Western countries].

Traditional treatment for papillary thyroid carcinoma confined in one lobe was subtotal thyroidectomy with ipsilateral modified neck dissection in Japan. Several guidelines reported from western countries differ in many aspects from Japanese traditional practice. They recommend total or near total thyroidectomy except for a small solitary cancer without nodal metastasis and modified neck dissection only if nodes are clinically involved. They also recommend ablation of remnant thyroid with radioactive iodine and TSH suppression with variable indications and intensities. According to the recent improvements in surgical techniques and change in medical and economical situations, we currently perform total thyroidectomy more frequently and hemithyroidectomy for a small cancer. We abandoned subtotal thyroidectomy basically. We still consider prophylactic neck dissection valuable in reducing nodal recurrence in selected patients.