ArticleTherapeutic advances in endocrinology and metabolism2026
Lobectomy versus total thyroidectomy for unilateral multifocal papillary thyroid carcinoma (⩽4 cm) with limited lymph node metastasis: a retrospective cohort study using inverse probability weighting.
Article in Therapeutic advances in endocrinology and metabolism, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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%; 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.
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