Related Experiment Video For Extrathyroidal extension
Updated: Nov 17, 2025
Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
The appropriateness of thyroid lobectomy as an initial surgery for preoperatively detected unilateral multifocal
Loai Saleh Albinsaad1, Won Woong Kim2, Yu-Mi Lee2
1Department of Surgery, College of Medicine, King Faisal University, Al-Ahsa City, Eastern Province, Saudi Arabia; Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, South Korea.
Background:
Whether multifocal papillary thyroid carcinoma (PTC) is more associated with recurrence than unifocal PTC is controversial. This study investigates the appropriateness of lobectomy for patients with preoperatively detected unilateral multifocal PTC.
Methods:
This study retrospectively analyzed 198 patients with unilateral multifocal PTC at the Asan Medical Center between 2000 and 2005. Clinicopathological features and locoregional recurrence rates were compared according to operation type (lobectomy, n = 62; total thyroidectomy (TT), n = 136).
Results:
The lateral neck lymph node area was the most frequent recurrence site. Univariate analyses showed that gross extrathyroidal extension (ETE), bilateral multifocal malignancy diagnosed after operation (bilaterality), lymph node (LN) metastasis, lymphovascular invasion, tumor size (≥2 vs < 2 cm), and extranodal extension (ENE) were associated with locoregional recurrence (P < 0.05). Multivariate analyses showed that ENE (hazard ratio (HR), 5.7; p = 0.007; 95% confidence interval (CI) = 1.1-9.8), LN metastasis (HR, 8.6; p = 0.046; 95% CI = 1.1-70.7), and lymphovascular invasion (HR, 11.1; p = 0.001; 95% CI = 2.7-46.1) were significantly associated with locoregional recurrence. The occult contralateral malignancy (rate, 15.4% of TT patients) and gross ETE were not risk factors for locoregional recurrence in the multivariate analysis of this study.
Conclusion:
Lobectomy may be considered as an alternative treatment to TT for patients with preoperatively detected unilateral multifocal PTC with diameters less than 2 cm, even in the pres-ence of risk fac-tors, such as gross ETE, and the pos-si-bil-ity of oc-cult ma-lig-nancy of the con-tralat-eral lobe. Although recurrence in the contralateral lobe after lobectomy could be diagnosed in unilateral multifocal PTC, it would not increase the rates of locoregional recurrence and death.
