Hemithyroidectomy versus total thyroidectomy for well differentiated T1-2 N0 thyroid cancer: systematic review and meta-analysis

Background: Evidence for limiting the extent of surgery in patients with low-risk thyroid cancer is lacking. Methods: A systematic search was performed according to the PRISMA and MOOSE guidelines to assess the effect of total thyroidectomy (TT) with or without radioactive iodine (RAI) treatmentversushemithyroidectomy (HT) on recurrence and overall mortality in patients with differentiated (papillary or follicular) T1-2 N0 thyroid cancer. PubMed, Embase and Cochrane databases were searched, and two authors independently assessed the articles. Results: A total of ten eligible articles were identified. All were observational cohort series, representing a total of 23 134 patients, of which 17 699 were available for meta-analysis. Six studies included patients who had TT followed by RAI treatment. The pooled recurrence rate after TT +/- RAI and HT was 2 center dot 3 and 2 center dot 8 per cent respectively (odds ratio (OR) 1 center dot 12, 95 per cent c.i. 0 center dot 82 to 1 center dot 53;P = 0 center dot 48). The pooled 20-year overall survival rate after TT +/- RAI was 96 center dot 8 per cent, compared with 97 center dot 4 per cent for HT (OR 1 center dot 30, 0 center dot 71 to 2 center dot 37;P = 0 center dot 40). Overall, higher complication rates were found in the TT +/- RAI group. Conclusion: Recurrence rates after HT for treatment of well differentiated T1-2 N0 thyroid cancer were similar to those after TT +/- RAI, with a lower incidence of treatment-related complications.