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Total thyroidectomy versus unilateral lobectomy for unilateral multifocal papillary thyroid carcinoma: systematic review and meta‑analysis

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Abstract

The optimal surgical procedure(s) for unilateral multifocal papillary thyroid carcinomas is currently controversial. As such, the present study aimed to compare the efficacies of total thyroidectomy and lobectomy in patients with unilateral multifocal papillary thyroid carcinoma. A literature search of the PubMed/Medline, Embase, Web of Science, Cochrane Library, Wan Fang, and Zhi Wang databases for relevant studies, published from inception to October 31, 2022, was performed. Two researchers independently extracted data from the included studies. Lymph node metastasis, vocal fold paralysis, parathyroid injury, postoperative recurrence, and disease-free survival were evaluated. The meta-analysis included 7 studies comprising 1540 patients, of whom 496 and 1044 underwent lobectomy and total thyroidectomy, respectively. Compared with lobectomy, total thyroidectomy resulted in more vocal cord paralysis (odds ratio [OR] 0.35 [95% confidence interval (CI) 0.13 to 0.96]; P = 0.04) and parathyroid injury (OR 0.11 [95% CI 0.03–0.39]; P = 0.001) but with better disease-free survival (OR 0.21 [95% CI 0.09–0.49]; P = 0.000), although vocal cord paralysis and parathyroid injury, in large part, resolved within 1 year after surgery. In addition, there was no difference in postoperative lymph nodes metastasis (OR 0.74 [95% CI 0.13–4.21]; P = 0.737) and postoperative recurrence (OR 2.37 [95% CI 0.42–13.38]; P = 0.33). Excluding studies that deviated from the general trend, total thyroidectomy was beneficial in reducing recurrence. Compared with lobectomy, total thyroidectomy was beneficial in reducing recurrence and disease-free survival and may be considered a more optimal approach for unilateral multifocal papillary thyroid carcinoma.

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Funding

This study was supported by the National Natural Science Foundation of China (Nos. 82073009, 81974424), the China Postdoctoral Science Foundation (No. 2022M723557), the Youth Science Foundation of **angya Hospital (No. 2022Q08), Changsha Natural Science Foundation (No. kq2208390) and the project of Postgraduate Independent Exploration and Innovation of Central South University (No. 2022ZZTS0823).

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Authors and Affiliations

  1. Department of Otolaryngology-Head and Neck Surgery, **angya Hospital, Central South University, 87 **angya Road, Changsha, Hunan, People’s Republic of China

    Huihong Chen, Yong Liu, Donghai Huang, **n Zhang & Li She

  2. Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, Hunan, People’s Republic of China

    Huihong Chen, Yong Liu, Donghai Huang, **n Zhang & Li She

  3. Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, Hunan, People’s Republic of China

    Huihong Chen, Yong Liu, Donghai Huang, **n Zhang & Li She

  4. National Clinical Research Center for Geriatric Disorders (**angya Hospital), 87 **angya Road, Changsha, Hunan, People’s Republic of China

    Yong Liu & **n Zhang

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  1. Huihong Chen
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Contributions

HC conception and design of the work; data acquisition, analysis and interpretation; drafting the work, final approval. YL: data acquisition, analysis and interpretation drafting and revising the work, final approval. DH: data acquisition, analysis and interpretation; drafting and revising the work, final approval. XZ: data acquisition, analysis and interpretation; drafting and revising the work, final approval. LS: data acquisition, analysis and interpretation; drafting and revising the work, final approval.

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Correspondence to Li She.

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Chen, H., Liu, Y., Huang, D. et al. Total thyroidectomy versus unilateral lobectomy for unilateral multifocal papillary thyroid carcinoma: systematic review and meta‑analysis. Updates Surg 76, 33–41 (2024). https://doi.org/10.1007/s13304-023-01726-x

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