Lobectomy Versus Total Thyroidectomy Across 2015 American Thyroid Association Low-to-Intermediate-Risk Papillary Thyroid Carcinoma.

Abstract

The 2015 American Thyroid Association guidelines recommend risk-stratified management of papillary thyroid cancer (PTC). Debate continues on whether upfront total thyroidectomy versus lobectomy confers improved survival in intermediate-risk PTC. This study aims to synthesize recurrence and survival data for optimal surgical management in risk-stratified PTC. PubMed, Embase, and Cochrane Library. Two independent reviewers searched and screened, from January 1, 2015, to April 26, 2025, articles comparing the prognostic outcomes of lobectomy or total thyroidectomy for PTC. Pooled analyses were performed where feasible, in recurrence-based outcomes across low-to-intermediate-risk cohorts. Additional sensitivity analyses were conducted. Qualitative analysis covered recurrence and mortality outcomes. Among 2670 identified records, 10 studies (n = 17,082) were included. Meta-analysis of intermediate-risk PTC (n = 3881) demonstrated comparable 5-year recurrence-free survival between lobectomy (96% [95% CI: 89%-99%], I² = 83.2%, P < .0001) and total thyroidectomy (95% [95% CI: 91%-97%], I² = 85.0%, P < .0001; hazard ratio [HR] 1.19 [95% CI: 0.69-2.04], I² = 33.8%, P = .2096). Pooled analysis of low-to-intermediate-risk cohorts (n = 1119) showed similar raw recurrence rates-lobectomy: 3% ([95% CI: 2%-7%], I² = 0%, P = .5777) versus total thyroidectomy: 4% ([95% CI: 1%-14%], I² = 92.7%, P < .0001). Systematic review of disease-specific survival (n = 3081) demonstrated no mortality benefit for total thyroidectomy across all risk groups. Thyroid lobectomy is sufficient in managing low-to-intermediate-risk PTC, reducing morbidity associated with upfront total thyroidectomy.