Thyroid lobectomy for unilateral TNM T1 and T2 papillary thyroid carcinoma patients with lateral lymph node metastasis.

BACKGROUND

This study aimed to evaluate the prognostic outcomes of thyroidectomy extent in unilateral TNM T1 or T2 papillary thyroid carcinoma with lateral lymph node metastasis.

METHODS

Retrospective data were collected from unilateral papillary thyroid carcinoma patients with unilateral lymph node metastasis who underwent surgery at Qilu Hospital of Shandong University from 2011 to 2022. Patients were categorized into 2 groups based on the extent of the thyroidectomy (total thyroidectomy versus lobectomy). The primary endpoint was recurrence-free survival. The secondary endpoint was the incidence of complications. The Cox proportional hazards model was used to explore independent risk factors for structural recurrence.

RESULTS

A total of 372 patients with unilateral TNM T1 or T2 papillary thyroid carcinoma and unilateral lymph node metastasis were followed for a median of 55 months. Among them, 119 patients underwent lobectomy, whereas 253 patients underwent total thyroidectomy. During the follow-up period, 11 patients experienced structural recurrence. Kaplan-Meier analysis found no significant difference in recurrence-free survival between the groups (P > .05). However, the total thyroidectomy group had higher rates of both transient and permanent hypoparathyroidism, as well as transient recurrent laryngeal nerve injury (P < .05). Multivariate analysis identified minor extrathyroidal extension and lymph nodes ratio >0.49 as independent risk factors for structural recurrence, whereas the extent of thyroidectomy was not.

CONCLUSION

This study suggests that lobectomy does not impact the prognosis in unilateral TNM T1 and T2 papillary thyroid carcinoma patients with unilateral lymph node metastasis. Minor extrathyroidal extension and lymph nodes ratio >0.49 are identified as independent risk factors for structure recurrence, and patients exhibiting these risk factors should be subjected to vigilant postoperative monitoring.