Hemi-Thyroidectomy versus Total Thyroidectomy in Patients with Low-Risk Papillary Thyroid Carcinoma Sized 2 cm or Less

The controversy over the optimal extent of thyroidectomy for papillary thyroid carcinoma (PTC) has persisted over a long time period. Particularly, there is a lack of consensus in low-risk PTC sized 1 cm and 2 cm. In this retrospective study, we analyzed the oncologic outcomes between hemi-thyroidectomy and total thyroidectomy in patients with low-risk PTC sized 2 cm or less. Materials and Methods: A retrospective chart review of 1107 patients who were diagnosed as unilateral low-risk PTC with maximal tumor size 2 cm or less and initially underwent either hemi-thyroidectomy (n=550) or total thyroidectomy (n=557) was conducted. All patients underwent ipsilateral prophylactic central neck dissection. Patients had no evidence of gross extrathyroidal extension or lymph node metastasis. Clinicopathologic factors and recurrence rate were compared according to the surgical extent and factors correlated to recurrence were analyzed. Results: While the total thyroidectomy group had more aggressive clinicopathologic factors such as minimal extrathyroidal extension, multifocality, and lymph node metastasis, recurrence rate was higher in the hemi-thyroidectomy group (p=0.006). However, when the contralateral lobe recurrence was excluded there was no difference in recurrence between the two groups (p=0.597). In patients with tumor sized 1 cm and 2 cm there was no significant difference in recurrence between the two groups (p=0.100). Conclusion: Total thyroidectomy may not decrease recurrence in patients with PTC presented with unilateral tumor sized 1 cm and 2 cm. Hemi-thyroidectomy could be considered the treatment of choice in these patients when they are presented as a low-risk group.