Abstract
Background
Optimal surgical extent for cT1-2N0 papillary thyroid carcinoma (PTC) remains debated.
Methods
This study included 400 consecutive low-risk cT1-2N0 PTC patients (tumor ≤4 cm, clinically node-negative) who underwent initial total thyroidectomy (TT, n = 250) or lobectomy (LT, n = 150) between 2020 and 2024. The primary descriptive outcome was completion thyroidectomy rate in the LT group; the primary oncologic outcome was recurrence-free survival (RFS). Multivariable regression and propensity score matching identified predictors and adjusted comparisons.
Results
TT was associated with longer operative time, hospital stay, and drainage volume (all
P
P
P
= 0.012); however, given only 21 recurrence events, this finding is exploratory. Among LT patients, 34.7% (52/150) ultimately required completion thyroidectomy due to pathologic upgrade. Independent predictors were tumor size (OR = 3.19/cm), multifocality (OR = 4.81), and positive lymph node count (OR = 2.61/node) (all
P
Conclusions
The oncologic safety of lobectomy for low-risk PTC is well-established. The key tradeoff is clear: lobectomy markedly reduces permanent hypoparathyroidism (0.7% vs 6.0%) but carries a one-in-three reoperation risk, predicted by tumor size, multifocality, and nodal burden. Although TT showed an exploratory RFS benefit, this finding requires confirmation. These tradeoffs must be explicitly discussed during preoperative counseling to enable informed, preference-sensitive decision-making.