Total thyroidectomy versus lobectomy for recurrence and complications of papillary thyroid microcarcinoma: a meta-analysis

Background: Surgical extent (Total thyroidectomy VS lobectomy) in papillary thyroid microcarcinoma (PTMC) remains controversial. The objective of this meta-analysis is to summarize recurrence and complication of these two procedures in PTMC. Methods: Electronic databases, PubMed, Cochrane Library and Web of Science were searched up to May 1, 2017. This meta-analysis was performed by Review Manager Version 5.2, Pooled odds ratios (ORs) with 95% confidence intervals (CIs) for recurrence and complications were calculated using random-effects models. And subgroup analysis were done to explore heterogeneity in extracted studies. Results: 15 eligible studies with a total of 21,223 patients were included. 13 trials (n=15,336 patients) evaluated the correlation between different surgery extent and recurrence rate, four (n=8,229 patients) analysed for complications. Meta-analysis of the pooled data revealed there is no significant difference in the recurrence rate between total thyroidectomy (TT) and lobectomy (LT) groups, (OR, 0.87; 95% CI, 0.60-1.27; P=0.47). TT group had a higher risk of complications (OR, 7.96; 95% CI, 1.06-59.4; P=0.04) mainly caused by transient hypoparathyroidism (OR, 13.16; 95% CI, 1.68-103.38; P=0.01) compared with the lobectomy group. No significant differences were observed between the two operative methods in terms of permanent hypoparathyroidism (OR, 5.26; 95% CI, 0.59-46.67; P=0.14) and recurrent laryngeal nerve injury (OR, 1.59; 95% CI, 0.41-6.20; P=0.50). Conclusion: This meta-analysis indicate, there is no significant difference in recurrence rate between total thyroidectomy and lobectomy surgical strategy, Lobectomy can also achieve comparable therapeutic effect and with low complications.