Impact of Extent of Surgery on Tumor Recurrence and Survival for Papillary Thyroid Cancer Patients

Background. The extent of surgery for low-risk papillary thyroid cancer (PTC) has been the subject of debate among experts for decades. Objective. In this paper, we aimed to systematically review whether thyroid lobectomy versus total thyroidectomy for PTC patients with tumors measuring 1.0-4.0 cm impacts tumor recurrence and survival. Results. A systematic review of the literature from January 1990 to February 2018 yielded 13 relevant studies, including eight national cancer registry database studies, one multi-institutional thyroid cancer-specific database, three large-scale institutional series, and one meta-analysis. Data from these studies demonstrate that total thyroidectomy for the treatment of PTC measuring 1.0-4.0 cm does not confer a clinically significant improvement in diseasespecific survival compared with thyroid lobectomy. Four of six studies also reported that total thyroidectomy is associated with a small but statistically significant improvement in disease-free survival, although it is argued whether this difference is clinically significant. Conclusions. While the quality of the data limit the strength of our conclusions, and while tumor characteristics, patient risk factors, and preferences should be considered, most data support that lobectomy and total thyroidectomy yield comparable oncologic outcomes for PTC measuring 1.0-4.0 cm.