Lobectomy vs. total thyroidectomy for unilateral papillary thyroid carcinoma with ipsilateral cervical lymph node metastasis
10.3760/cma.j.cn115807-20240229-00060
- VernacularTitle:单侧甲状腺乳头状癌伴同侧颈侧区淋巴结转移：腺叶切除还是全甲状腺切除？
- Author:
Shijia ZHANG
1
;
Kehui ZHOU
1
;
Ming ZHAO
1
;
Xiaochun MAO
1
;
Jinbiao SHANG
1
;
Xiabin LAN
1
Author Information
1. 温州医科大学研究生培养基地（浙江省肿瘤医院），浙江省肿瘤医院甲状腺外科，杭州 310022
- Publication Type:Journal Article
- Keywords:
Unilateral lobectomy;
Total thyroidectomy;
Papillary thyroid cancer;
Propensity score matching;
Recurrence-free survival
- From:
Chinese Journal of Endocrine Surgery
2025;19(1):57-62
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the benefits and prognostic risks of unilateral lobectomy (with or without isthmusectomy) or total (or near-total) thyroidectomy for primary foci of unilateral papillary thyroid cancer (PTC) patients with ipsilateral lateral cervical lymph node metastasis (LLNM) , so as to find out the optimal surgery for these patients.Methods:A total of 505 unilateral PTC patients with ipsilateral LLNM who underwent initial surgical treatment at the Thyroid Surgery Department of Zhejiang Cancer Hospital from Feb. 2012 to Jan. 2020 were retrospectively reviewed. The patients were divided into unilateral lobectomy group ( n=314) and total thyroidectomy group ( n=191) according to the extent of resection of primary foci. Then 177 pairs of cases were screened out after eliminating the potential confounding bias between the two groups by using propensity score matching (PSM) , analyzing the differences in clinical outcomes such as recurrence-free survival (RFS) , overall survival (OS) , hospitalization costs, and postoperative complications between the two groups. Results:After PSM, the postoperative complication rate was 37.3% ( n=66) in the total thyroidectomy group and 3.4% ( n=6) in the unilateral lobectomy group. The complication was mainly characterized by temporary hypoparathyroidism (HP) . Although the difference in length of hospitalization between the two groups was not statistically significant ( P=0.792) , patients in the unilateral lobectomy group used less surgical time ( P<0.001) , had lower hospitalization and surgical costs ( P<0.0001) , and took a relatively smaller dose of levothyroxine (L-T4) one month after the operation ( P<0.0001) , as compared with the total thyroidectomy group. Univariate analysis showed that the number of LLNM total lymph node metastasis (LNM) rate, LLNM rate, and T stage were significant risk factors for relapse. Multi-factor regression analysis indicated that T-staging was a risk factor for recurrence. After a median follow-up of 60 (3-138) months, 19 patients (10.7%) in the unilateral lobectomy group and 11 patients (6.2%) in the total thyroidectomy group recurred, with no statistical difference between the two groups ( P=0.133) . The OS curve displayed no significant difference between the unilateral lobectomy and total thyroidectomy groups ( P=0.740) . Conclusion:For unilateral PTC patients with ipsilateral LLNM without other high-risk features, unilateral lobectomy could be a better option.
