title: Total thyroidectomy versus lobectomy as initial operation for small unilateral papillary thyroid carcinoma: A meta-analysis.
abstract: BACKGROUND
  Consensus guidelines have recommended total thyroidectomy for papillary thyroid carcinoma (PTC) > 1 cm. However, the optimal surgical approach for small and unilateral (≤1 cm) PTC remains controversial.
  
  
  METHODS
  A meta-analysis was performed using MEDLINE and EMBASE databases to identify all studies investigating at thyroid surgery options, total thyroidectomy (TT) versus thyroid lobectomy (TL), for PTC ≤ 1 cm. The primary endpoints were locoregional recurrence and mortality rates.
  
  
  RESULTS
  The initial literature search identified 305 publications (1980-2014). Six studies met the inclusion criteria comprising 2939 patients (2002-2013). Among these patients, 2134 (72.6%) underwent TT and 805 (27.4%) underwent TL. Mean follow-up was 10.9 ± 3.4 years (range, 1 month to 54 years). Overall, the recurrence rate was 5.4%: 4.4% in the TT group and 8.3% in the TL group (p < 0.001; RR 0.50, 95% CI 0.37-0.67). The mortality rates were 0.3% (8 cases) versus 1.1% (9 cases) in TT and TL groups, respectively (p = 0.14; RR 0.43, 95% CI 0.17-1.09).
  
  
  CONCLUSIONS
  TT was associated with lower recurrence rates, possibly due to a more complete nodal dissection of the central neck compartment at the time of initial surgery. Based on these data, it is unclear to establish a definitive correlation between the extent of thyroid resection and long-term survival rates due to the small number of mortality events. However, there is a trend toward lower mortality rates in the TT group. Other factors need to be taken into consideration while planning thyroid resection for small PTC, such as multifocality, locoregional involvement, mode of presentation and age at diagnosis. Refinement of current guidelines for the optimal surgical management of PTC <1 cm may be warranted.
authors.affiliation: Department of General Surgery, Providence Hospital and Medical Centers, Southfield, MI, USA. Electronic address: franciscoigor.macedo@stjohn.org.
authors.forename: Francisco Igor B
authors.initials: FI
authors.lastname: Macedo
authors.affiliation: Department of General Surgery, Providence Hospital and Medical Centers, Southfield, MI, USA.
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Mittal
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000401:mortality / Q000601:surgery*; D002291:Carcinoma, Papillary; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery; D000077273:Thyroid Cancer, Papillary; D013964:Thyroid Neoplasms / Q000401:mortality / Q000601:surgery*; D013965:Thyroidectomy / Q000379:methods* / Q000401:mortality; D016896:Treatment Outcome
keywords: Lobectomy; Mortality; Papillary thyroid cancer; Recurrence; Total thyroidectomy