Total thyroidectomy versus lobectomy as initial operation for small unilateral papillary thyroid carcinoma: A meta-analysis

• The optimal surgical approach for small unilateral (≤1 cm) PTC remains controversial.
• This meta-analysis included six studies (TT vs. TL) comprising 2939 patients.
• TT was associated with lower recurrence rates compared to TL (4.4% vs. 8.3%).
• There is a trend toward lower mortality after TT even though prognosis is excellent.
• Refinement of current guidelines for the surgical management of PTC ≤1 cm is needed.

IntroductionConsensus guidelines have recommended total thyroidectomy for papillary thyroid carcinoma (PTC) > 1 cm. However, the optimal surgical approach for small and unilateral (≤1 cm) PTC remains controversial.MethodsA meta-analysis was performed using MEDLINE and EMBASE databases to identify all studies investigating at thyroid surgery options, total thyroidectomy (TT) versus thyroid lobectomy (TL), for PTC ≤ 1 cm. The primary endpoints were locoregional recurrence and mortality rates.ResultsThe initial literature search identified 305 publications (1980–2014). Six studies met the inclusion criteria comprising 2939 patients (2002–2013). Among these patients, 2134 (72.6%) underwent TT and 805 (27.4%) underwent TL. Mean follow-up was 10.9 ± 3.4 years (range, 1 month to 54 years). Overall, the recurrence rate was 5.4%: 4.4% in the TT group and 8.3% in the TL group (p < 0.001; RR 0.50, 95% CI 0.37–0.67). The mortality rates were 0.3% (8 cases) versus 1.1% (9 cases) in TT and TL groups, respectively (p = 0.14; RR 0.43, 95% CI 0.17–1.09).ConclusionTT was associated with lower recurrence rates, possibly due to a more complete nodal dissection of the central neck compartment at the time of initial surgery. Based on these data, it is unclear to establish a definitive correlation between the extent of thyroid resection and long-term survival rates due to the small number of mortality events. However, there is a trend toward lower mortality rates in the TT group. Other factors need to be taken into consideration while planning thyr oid resection for small PTC, such as multifocality, locoregional involvement, mode of presentation and age at diagnosis. Refinement of current guidelines for the optimal surgical management of PTC <1 cm may be warranted.