Innovative Approaches in Thyroid Cancer Surgery: A Comparative Study of Total vs. Partial Thyroidectomy; Systematic Review
DOI:
https://doi.org/10.69980/ajpr.v28i5.452Keywords:
Thyroid cancer, Papillary thyroid carcinoma, Total thyroidectomy, Partial thyroidectomy, LobectomyAbstract
Background: Thyroid cancer, predominantly papillary thyroid carcinoma (PTC), has seen a rising global incidence due to advancements in diagnostic techniques. Total thyroidectomy (TT) and partial thyroidectomy (PT), especially lobectomy, are the primary surgical treatments. Recent innovations, including robotic and endoscopic techniques, have reshaped the surgical landscape.
Objective: This systematic review evaluates and compares TT and PT in the management of intermediate-risk PTC, emphasizing surgical outcomes, complications, recurrence, and the role of innovative approaches.
Methods: A comprehensive search of PubMed, Embase, and Cochrane Library databases identified comparative studies up to April 2025. Eight retrospective cohort studies involving 2,984 patients were included. Key outcomes assessed were recurrence rates, surgical complications, and postoperative recovery metrics. Data were synthesized using RevMan 5.4 with subgroup and sensitivity analyses.
Results: Recurrence rates were similar between TT and PT groups. PT demonstrated fewer overall complications, particularly transient hypocalcemia and recurrent laryngeal nerve palsy. Cosmetic satisfaction and recovery metrics favored PT. No significant difference was found in permanent complications or recurrence. The inclusion of minimally invasive and robotic techniques was associated with enhanced cosmetic and functional outcomes.
Conclusions: Partial thyroidectomy offers comparable oncologic control to total thyroidectomy in appropriately selected patients with intermediate-risk PTC, with the added benefit of fewer complications and better postoperative quality of life. Ongoing innovation in surgical techniques further supports the shift toward conservative management when clinically appropriate.
References
1. MedlinePlus (National Library of Medicine). Thyroid tests [Internet]. [cited 2025 Apr 12]. Available from: https://medlineplus.gov/thyroidtests.html
2. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Hypothyroidism [Internet]. [cited 2025 Apr 12]. Available from: https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism
3. DynaMed. Papillary thyroid cancer in adults [Internet]. Ipswich (MA): EBSCO Information Services; 2024 Nov 19 [cited 2025 Apr 12]. Available from: https://www.dynamed.com/condition/papillary-thyroid-cancer-in-adults
4. American Cancer Society. Key statistics for thyroid cancer [Internet]. Atlanta: American Cancer Society; 2024 Jan 12 [cited 2025 Apr 12]. Available from: https://www.cancer.org/cancer/types/thyroid-cancer/about/key-statistics.html
5. Dana-Farber Cancer Institute. Thyroid cancer [Internet]. Boston: Dana-Farber Cancer Institute; 2023 [cited 2025 Apr 12]. Available from: https://www.dana-farber.org/cancer-care/types/thyroid-cancer
6. Cochrane Library. Total or near‐total thyroidectomy versus subtotal thyroidectomy for multinodular non‐toxic goitre in adults [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2014 Sep 25 [cited 2025 Apr 12]. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD010370.pub2/full
7. Pelizzo MR, Rubello D, Casara D, Fassina A, Busnardo B. The efficacy and safety of total thyroidectomy in the management of benign thyroid disease: a review of 932 cases. J Endocrinol Invest. 2008 Dec;31(12):1056–62. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC2637645/
8. Lin Y, Zhou Y, Xu B. Comparison of short-term outcomes following minimally invasive (endoscopic/robotic) vs open thyroidectomy for patients with thyroid cancer. Eur Thyroid J. 2025 Mar;14(2):e240134. Available from: https://etj.bioscientifica.com/view/journals/etj/14/2/ETJ-24-0134.xml
9. Lee J, Kim SH. Surgical outcomes of minimally invasive thyroidectomy in thyroid cancer: comparison with conventional open thyroidectomy. Gland Surg. 2016 Jun;5(3):281–9. Available from: https://gs.amegroups.org/article/view/53746/html
10. Miccoli P, Berti P, Raffaelli M, Livraghi L, Valeri A, Picone A, et al. Minimally invasive thyroidectomy: a ten years experience. Updates Surg. 2016 Jun;68(2):199–203. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC4884693/
11. Li Z, Liu F, Zhang Y, Jiang S, Wang H, Sun Y, et al. Research progress on artificial intelligence technology-assisted diagnosis of thyroid diseases. Front Oncol. 2025 Mar 27;15:1536039. Available from: https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2025.1536039/full
12. Liu F, Li Z, Zhang Y, Jiang S, Wang H, Sun Y, et al. Quantitative analysis of studies that use artificial intelligence on thyroid cancer. Front Oncol. 2025 Mar 18;15:1525650. Available from: https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2025.1525650/pdf
13. Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol. 2005;5:1.
14. Tsui KP, Kwan WY, Chow TL. Total vs hemithyroidectomy for intermediate risk papillary thyroid cancer: a 23 year retrospective study in a tertiary center. Am J Otolaryngol. 2019;40:431–4.
15. Jeon YW, Gwak HG, Lim ST, et al. Long-term prognosis of unilateral and multifocal papillary thyroid microcarcinoma after unilateral lobectomy versus total thyroidectomy. Ann Surg Oncol. 2019;26:2952–8.
16. Ji YB, Song CM, Kim D, et al. Efficacy of hemithyroidectomy in papillary thyroid carcinoma with minimal extrathyroidal extension. Eur Arch Otorhinolaryngol. 2019;276:3435–42.
17. Liu J, Zhang Z, Huang H, et al. Total thyroidectomy versus lobectomy for intermediate-risk papillary thyroid carcinoma: a single-institution matched-pair analysis. Oral Oncol. 2019;90:17–22.
18. Horiuchi K, Fujimoto M, Hidenori K, et al. Outcomes of patients with an intermediate‐risk group according to the Japanese Risk Classification of papillary thyroid carcinoma. World J Surg. 2023;47:2464–73.
19. Xu S, Huang H, Huang Y, et al. Comparison of lobectomy vs total thyroidectomy for intermediate-risk papillary thyroid carcinoma with lymph node metastasis. JAMA Surg. 2023;158:73.
20. Wang Z, Xiang J, Gui Z, et al. Unilateral TNM T1 and T2 papillary thyroid carcinoma with lateral cervical lymph node metastasis: total thyroidectomy or lobectomy? Endocr Pract. 2020;26:1085–92.
21. Dobrinja C, Samardzic N, Giudici F, et al. Hemithyroidectomy versus total thyroidectomy in the intermediate-risk differentiated thyroid cancer: the Italian Societies of Endocrine Surgeons and Surgical Oncology multicentric study. Updates Surg. 2021;73:1909–21.
22. Chen C, Huang S, Huang A, Jia Y, Wang J, Mao M, et al. Total endoscopic thyroidectomy versus conventional open thyroidectomy in thyroid cancer: a systematic review and meta-analysis. Ther Clin Risk Manag. 2018;14:2349–61.
23. Padur AA, Kumar N, Guru A, Badagabettu SN, Shanthakumar SR, Virupakshamurthy MB, et al. Safety and effectiveness of total thyroidectomy and its comparison with subtotal thyroidectomy and other thyroid surgeries: a systematic review. J Thyroid Res. 2016;2016:7594615.
24. Di Filippo L, Giugliano G, Tagliabue M, Gandini S, Sileo F, Allora A, et al. Total thyroidectomy versus lobectomy: surgical approach to T1–T2 papillary thyroid cancer. Acta Otorhinolaryngol Ital. 2020;40(4):254.
25. Lu Q, Zhu X, Wang P, Xue S, Chen G. Comparisons of different approaches and incisions of thyroid surgery and selection strategy. Front Endocrinol (Lausanne). 2023;14:1166820.
26. Kuba S, Yamanouchi K, Hayashida N, Maeda S, Adachi T, Sakimura C, et al. Total thyroidectomy versus thyroid lobectomy for papillary thyroid cancer: comparative analysis after propensity score matching: a multicenter study. Int J Surg. 2017;38:143–8.
27. Lee S, Ryu HR, Park JH, Kim KH, Kang SW, Jeong JJ, et al. Early surgical outcomes comparison between robotic and conventional open thyroid surgery for papillary thyroid microcarcinoma. Surgery. 2012;151(5):724–30.
28. Rossi L, Materazzi G, Bakkar S, Miccoli P. Recent trends in surgical approach to thyroid cancer. Front Endocrinol (Lausanne). 2021;12:699805.
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