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Updated: Jul 12, 2026
Transoral Robotic Total Thyroidectomy and Bilateral Central Regional Lymph Node Dissection for Papillary Thyroid Carcinoma
Published on: September 15, 2023
Lobectomy versus total thyroidectomy for unilateral multifocal papillary thyroid carcinoma (⩽4 cm) with limited lymph
Changjiao Yan1, Xin Li1, Yang Wang1
1Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China.
Background:
The optimal extent of surgery for patients with unilateral multifocal papillary thyroid carcinoma (PTC; ⩽4 cm) and limited lymph node metastasis remains uncertain.
Objectives:
To compare recurrence risk between lobectomy and total thyroidectomy in this population.
Design:
Retrospective cohort study with inverse probability weighting regression adjustment (IPWRA) and non-inferiority analysis.
Methods:
This study included unilateral multifocal PTC (⩽4 cm) patients without bulky nodes (all metastatic <3 cm) treated from 2008 to 2024. IPWRA estimated the average treatment effect (ATE) of lobectomy versus total thyroidectomy on recurrence. A non-inferiority analysis with a prespecified margin of 3% was performed. Sensitivity analyses included traditional multivariable logistic regression, 1:1 propensity score matching, weighted logistic regression, and a 5-year landmark analysis. Recurrence-free survival was analyzed using Kaplan-Meier methods and multivariable Cox regression.
Results:
A total of 1373 patients were included (524 lobectomy, 849 total thyroidectomy). After IPWRA, all covariates achieved excellent balance. Over 52.4 months median follow-up, 36 recurrence events occurred (2.6%). The ATE of lobectomy versus total thyroidectomy was 1.19% (95% confidence interval (CI): -1.44% to 3.81%; p = 0.375), indicating no statistically significant difference in recurrence risk between the two procedures. The upper bound of the 90% CI (3.39%) marginally exceeded the prespecified non-inferiority margin of 3%. The 5-year landmark analysis showed a near-zero difference (ATE 0.01%, p = 0.994), and three of four sensitivity analyses yielded nonsignificant results. Subgroup analyses were directionally consistent but underpowered. The multivariable Cox regression was underpowered (minimum detectable hazard ratio (HR): 2.61) and yielded an inconclusive result (HR: 2.04, 95% CI: 0.91-4.62, p = 0.085).
Conclusion:
In patients with unilateral multifocal PTC (⩽4 cm) without bulky nodal metastases, lobectomy showed no significant difference in recurrence risk compared with total thyroidectomy, supporting that lobectomy may be a safe alternative in this intermediate-risk population.
