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Meta-Analysis
. 2025 Nov;173(5):1099-1110.
doi: 10.1002/ohn.70009. Epub 2025 Sep 2.

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

Ryan Seng Hong Wong  1 , Trishan Manav Sri Ram  1 , Yuelin Xia  1 , E Han Heng  1 , Jayanth Jayabaskaran  1 , Yau Hua Lim  2 , Brian Sheng Yep Yeo  1 , Anna See  3   4   5 , Chwee Ming Lim  3   4   5   6
Affiliations
Meta-Analysis

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

Ryan Seng Hong Wong et al. Otolaryngol Head Neck Surg. 2025 Nov.

Abstract

Objective: 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.

Data sources: PubMed, Embase, and Cochrane Library.

Review methods: 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.

Results: 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.

Conclusion: Thyroid lobectomy is sufficient in managing low-to-intermediate-risk PTC, reducing morbidity associated with upfront total thyroidectomy.

Keywords: lobectomy; papillary thyroid cancer; risk‐stratification; total thyroidectomy.

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References

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