The preferred surgical choice for intermediate-risk papillary thyroid cancer: total thyroidectomy or lobectomy? A systematic review and meta-analysis

Background: The optimal surgical approach for intermediate-risk papillary thyroid carcinoma (IR-PTC) (according to ATA definition), whether total thyroidectomy (TT) or lobectomy (LT), has remained a contentious clinical gray area for several decades. This systematic review and meta-analysis aim to provide robust evidence and address this clinical dilemma comprehensively. Materials and methods: A comprehensive literature search was conducted in Pubmed, Embase, Web of Science, and the Cochrane Library from 1st January 2009 to 29th December 2023 to evaluate the impact of different surgical options (TT or LT) on patients with IR-PTC. The primary outcomes included survival, recurrence rates, and postoperative complications. I 2 and sensitivity analysis was used to explore the heterogeneity. Results: A total of 8 studies involving 2984 participants were included in this meta-analysis and systematic review. The results indicated that LT was a superior choice for mitigating complications compared to TT [risk ratio (RR), 0.32; 95% CI: 0.24-0.44, P<0.01], particularly for transient complications (RR, 0.24; 95% CI: 0.08-0.65, P<0.01), such as the transient parathyroid dysfunction (RR, 0.04; 95% CI: 0.01-0.15, P<0.01). However, TT did not increase the risk of recurrent laryngeal nerve palsy (RR, 0.78; 95% CI: 0.24-2.47, P=0.67), hemorrhage/seroma (RR, 0.77; 95% CI: 0.48-1.25, P=0.30), and permanent complications (RR, 0.18; 95% CI: 0.02-1.42, P=0.10). Besides, both LT and TT presented similar effect on survival outcomes (overall survival: RR, 1.00; 95% CI: 0.97-1.03, P=0.92, disease-specific survival: RR, 0.99; 95% CI: 0.97-1.02, P=0.69, recurrence-free survival: RR, 1.00; 95% CI: 0.96-1.05, P=0.86), recurrence (RR, 1.05; 95% CI: 0.76-1.46, P=0.76). Conclusion:The present meta-analysis revealed that TT did not yield improved outcomes in IR-PTC patients, but was associated with an increased incidence of temporary complications. In light of these findings, it may be advisable to consider LT as the optimal choice for IR-PTC patients.