Papillary carcinoma is the most common malignancy originating from the thyroid. Although most cases demonstrate indolent characteristics with an excellent prognosis, some lesions show certain clinicopathological characteristics and rapid growth. There are two therapeutic options of papillary carcinoma. One is observation, which is applicable to low-risk papillary microcarcinoma, i.e. papillary carcinoma measuring 1.0 cm or less.  In our department, over 300 patients to date have undergone observation and evidence of progression such as enlargement of tumor and novel appearance of lymph node metastasis were observed only in 7% of patients. None of the patients showed distant metastasis during observation or died of carcinoma. The second therapeutic option for papillary carcinoma is surgical treatment for tumors larger than 1.0 cm and for high-risk papillary microcarcinoma.  Surgery for papillary carcinoma consists of two compartments, thyroidectomy and lymph node dissection.  Previous major guidelines for thyroid surgery from Western countries recommended total thyroidectomy, but in Japan, there has been a lower prevalence of total thyroidectomy.  However, in contrast to Western countries, lymph node dissection, especially prophylactic node dissection is extensively performed in Japan. The indications for prophylactic node dissection are controversial, but the lymph node recurrence rate is significantly higher in patients with tumors larger than 3cm or showing massive extrathyroid extension, even when prophylactic node dissection has been performed. It is therefore suggested that prophylactic node dissection is recommended for such cases. Most prognostic factors of papillary carcinoma can be evaluated preoperatively or intra operatively. Therefore, appropriate surgical designs should be determined after accurate evaluation of the biological characteristics of each carcinoma before and during surgery. There are some important pathological findings such as poor differentiation, but the criteria remain complicated and difficult to evaluate.