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Updated: Jan 18, 2026
Transoral Endoscopic Thyroidectomy Vestibular Approach for Thyroid Lobectomy
Published on: May 12, 2023
Lobectomy or Total Thyroidectomy in Pediatric Differentiated Thyroid Cancer? A Systematic Review and Meta-Analysis
Ioanna Gkalonaki1, Athina Stamati2, Athanasios Christoforidis3
1First Department of Pediatric Surgery, Aristotle University of Thessaloniki, General Hospital "G. Gennimatas", Thessaloniki, Greece.
Insights
Radical total thyroidectomy is preferred for pediatric differentiated thyroid cancer (DTC) over lobectomy, as it shows lower recurrence and reoperation rates. Further randomized trials are needed to confirm these findings for pediatric thyroid cancer management.
Area of Science:
- Pediatric Oncology
- Surgical Oncology
- Endocrinology
Background:
- Pediatric differentiated thyroid cancer (DTC) presents differently than adult DTC.
- Management and outcomes vary significantly between pediatric and adult thyroid cancer patients.
Purpose of the Study:
- To compare radical total thyroidectomy versus lobectomy for pediatric DTC.
- To assess outcomes including recurrence, mortality, and complications.
Main Methods:
- Searched MEDLINE, CENTRAL, ClinicalTrials.gov, and congress abstracts up to September 2023.
- Assessed study quality using Cochrane risk of bias tools (ROBINS-I) and evidence quality with GRADE.
- Included 22 observational studies with 11,684 pediatric patients.
Main Results:
- No significant differences in mortality, overall complications, or recurrent laryngeal nerve palsy (RLNP).
- Lobectomy group had higher recurrence rates (RR 1.80) and reoperation needs (RR 3.99).
- Lobectomy group showed decreased permanent hypoparathyroidism (RR 0.23) and postoperative radioiodine (RAI) use (RR 0.42).
Conclusions:
- Total thyroidectomy is favored for pediatric thyroid cancer due to lower recurrence and reoperation rates.
- Further high-quality randomized controlled trials are recommended for definitive conclusions.
Background:
Thyroid cancer in pediatric patients is distinct from adult-onset thyroid cancer due to differences in disease presentation, management and outcomes. This meta-analysis delves into contemporary data on managing pediatric differentiated thyroid cancer (DTC), assessing outcomes, such as recurrence and mortality, in children with radical total thyroidectomy versus the more conservative lobectomy approach.
Methods:
MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), trial registry websites (ClinicalTrials.gov), and relevant congress abstracts were searched to identify eligible articles from the database inception to September 2023. Assessing study quality involved the Cochrane risk of bias tools (ROBINS-I), and overall evidence quality was gauged with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) tool. Investigated outcomes included recurrence rates, mortality rates, postoperative complications and independently permanent hypoparathyroidism and recurrent laryngeal nerve palsy (RLNP), postoperative radioiodine (RAI) and reoperation.
Results:
Twenty-two observational studies with 11,684 patients were included. No significant difference was seen between the two groups regarding the mortality rates, overall postoperative complications and RLNP. The meta-analysis demonstrated that in the thyroid lobectomy group, the recurrence rate [relative risk (RR 1.80, 95 % confidence interval (CI) 1.22-2.67] and need for reoperation were higher (RR 3.99, 95 % CI 2.01-7.92), while permanent hypoparathyroidism (RR 0.23, 95 % CI 0.11-0.49) and postoperative RAI (RR 0.42, 95 % CI 0.20-0.87) decreased.
Conclusion:
Total thyroidectomy is favored in pediatric thyroid cancer, showing lower recurrence and reoperation rates compared to lobectomy. For more robust findings, we strongly advocate for the implementation of well-designed randomized controlled trials.
