Gland surgery · 2026
Clinical outcomes of lobectomy versus isthmusectomy for clinically node-negative solitary isthmic papillary thyroid microcarcinoma: a retrospective cohort study.
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Zhu Feng, Zhu Li-Xian, Shen Yi-Bin, Li Meng-Xia, Xie Xiao-Jun, Wu Yi-Jun
Аннотация
BACKGROUND: The optimal surgical extent for isthmic papillary thyroid microcarcinoma (iPTMC) remains controversial. This study aimed to compare the oncological and surgical outcomes of isthmusectomy (IT) and lobectomy (LT) in patients with clinically node-negative (cN0) solitary iPTMC.
METHODS: We retrospectively analyzed 303 consecutive patients with cN0 solitary iPTMC who underwent thyroid surgery between 2017 and 2024. Patients with multifocal disease, tumor size >1 cm, clinically positive lymph nodes, gross extrathyroidal extension (gETE), non-PTC pathology, prior neck irradiation, or reoperative thyroid surgery were excluded. Baseline clinicopathologic variables, including age, sex, tumor size, central lymph node metastasis (CLNM), microscopic extrathyroidal extension (mETE), and recurrence were collected and compared between the IT and LT groups. Postoperative complications and levothyroxine requirements were evaluated. Propensity score matching (PSM) was performed to minimize selection bias. Patients were routinely followed up at 3-6-month intervals with ultrasonography (US) and assessment of thyroid function. Recurrence-free survival (RFS) was analyzed using the Kaplan-Meier method.
RESULTS: Among the 303 patients, 96 underwent IT and 207 underwent LT. Before PSM, baseline characteristics were comparable between groups, including age, sex, tumor size, CLNM, and mETE. After 1:2 PSM, 85 IT patients were matched with 146 LT patients, and baseline characteristics remained well balanced between the groups. The IT group had a significantly higher median number of dissected central lymph nodes (CLNs) and a shorter operative time (P<0.001 and P<0.001, respectively). Transient hoarseness was more frequent in the LT group (5.8% vs. 0%), while hypocalcemia rates were comparable. The median levothyroxine dose was significantly higher in the LT group (P<0.001). Recurrence occurred in 4.2% of the IT group and 3.4% of the LT group, with no statistically significant difference (P=0.73). Kaplan-Meier curves showed that RFS was comparable between the groups both before (P=0.12) and after PSM (P=0.10). Multivariate analysis showed that the CLNM was independent predictor of poor RFS (P=0.007).
CONCLUSIONS: Preliminary findings from this retrospective analysis suggest that isthmusectomy could be a viable, tissue-preserving alternative for selected iPTMC patients, potentially reducing levothyroxine requirements and postoperative complications. However, given the inherent selection bias, these results should be interpreted with caution. Furthermore, considering the high incidence of occult CLNM, the necessity of prophylactic CLN dissection warrants further validation in prospective studies.
METHODS: We retrospectively analyzed 303 consecutive patients with cN0 solitary iPTMC who underwent thyroid surgery between 2017 and 2024. Patients with multifocal disease, tumor size >1 cm, clinically positive lymph nodes, gross extrathyroidal extension (gETE), non-PTC pathology, prior neck irradiation, or reoperative thyroid surgery were excluded. Baseline clinicopathologic variables, including age, sex, tumor size, central lymph node metastasis (CLNM), microscopic extrathyroidal extension (mETE), and recurrence were collected and compared between the IT and LT groups. Postoperative complications and levothyroxine requirements were evaluated. Propensity score matching (PSM) was performed to minimize selection bias. Patients were routinely followed up at 3-6-month intervals with ultrasonography (US) and assessment of thyroid function. Recurrence-free survival (RFS) was analyzed using the Kaplan-Meier method.
RESULTS: Among the 303 patients, 96 underwent IT and 207 underwent LT. Before PSM, baseline characteristics were comparable between groups, including age, sex, tumor size, CLNM, and mETE. After 1:2 PSM, 85 IT patients were matched with 146 LT patients, and baseline characteristics remained well balanced between the groups. The IT group had a significantly higher median number of dissected central lymph nodes (CLNs) and a shorter operative time (P<0.001 and P<0.001, respectively). Transient hoarseness was more frequent in the LT group (5.8% vs. 0%), while hypocalcemia rates were comparable. The median levothyroxine dose was significantly higher in the LT group (P<0.001). Recurrence occurred in 4.2% of the IT group and 3.4% of the LT group, with no statistically significant difference (P=0.73). Kaplan-Meier curves showed that RFS was comparable between the groups both before (P=0.12) and after PSM (P=0.10). Multivariate analysis showed that the CLNM was independent predictor of poor RFS (P=0.007).
CONCLUSIONS: Preliminary findings from this retrospective analysis suggest that isthmusectomy could be a viable, tissue-preserving alternative for selected iPTMC patients, potentially reducing levothyroxine requirements and postoperative complications. However, given the inherent selection bias, these results should be interpreted with caution. Furthermore, considering the high incidence of occult CLNM, the necessity of prophylactic CLN dissection warrants further validation in prospective studies.