Thermal Ablation versus Surgical Resection for US-Detected Solitary cT1N0M0 Papillary Thyroid Carcinoma in Elderly Patients: A Multicenter Comparative Study

OBJECTIVE: This study was aimed to compare the effectiveness and complication rates of thermal ablation (TA) versus surgical resection (SR) in managing US-Detected solitary T1N0M0 papillary thyroid carcinoma (PTC) in elderly patients, including those with occult lymph node metastasis (LNM). MATERIALS AND METHODS: This retrospective, multicenter study involved 225 elderly patients with solitary PTC who underwent TA or SR. Propensity score matching (PSM) was used to minimize confounding factors. After PSM, the SR group was divided into SR-T1N0 and SR-T1N1 subgroups based on postoperative lymph node pathology. Disease progression and complications were compared across groups. RESULTS: Seventy-eight patients underwent TA, and 147 underwent SR. No significant difference in disease progression was found (2.6% vs. 1.4%; p = 0.860), including new tumors and LNM. After PSM, no differences were observed between groups (TA vs. SR-T1N0/SR-T1N1) (p > 0.05). Major complications were similar, but permanent hoarseness and hypoparathyroidism occurred only in the SR group. The TA group had significantly fewer side effects (0% vs. 25.9%, p < 0.001). CONCLUSION: In elderly patients with US-detected solitary T1N0M0 PTC, disease progression was similar between TA and SR. However, TA better preserves thyroid function, making it a safer and effective treatment for this population. ADVANCES IN KNOWLEDGE: This study demonstrates that TA is as effective as SR in elderly patients with US-detected solitary T1N0M0 PTC, including those with occult LNM, while better preserving organ function. This makes it a viable option for patients unable or unwilling to undergo SR.