Abstract Background Differentiated thyroid cancer (DTC) is common. The 2015 American Thyroid Association guidelines allow total thyroidectomy (TT) or less-than-total thyroidectomy (LTT) for low-risk disease ≤4 cm; comparative outcomes are uncertain. This systematic review and meta-analysis compared LTT versus TT. Methods PubMed, Cochrane Library, Scopus, and Web of Science were searched to October 2024 for adult DTC studies comparing LTT and TT. Outcomes: locoregional recurrence, distant metastasis, reoperation, disease-specific mortality, and postoperative complications (hypocalcemia, recurrent laryngeal nerve RLN injury, hematoma/seroma). Random-effects models with I² were used (R 4.4.0). Results Thirty-three studies (n = 37 899; LTT 13 162 35%, TT 24 737 65%; mean age 35–70; follow-up 6–144 months) were included. LTT had higher odds of locoregional recurrence (OR 1.806, 95% c.i. 1.401–2.329; P 0.001; I² = 48.6) and reoperation (OR 7.174, 95% c.i. 1.232–41.763; P = 0.03; I² = 75.0), with no significant difference in distant metastasis (OR 0.561, 95% c.i. 0.227–1.391; P = 0.21; I² = 0) or disease-specific mortality (OR 0.822, 95% c.i. 0.548–1.234; P = 0.34; I² = 0). Transient complications (hypocalcemia, hypoparathyroidism, RLN injury) were less frequent with LTT (OR 0.139, 95% c.i. 0.079–0.243; P 0.001; I² = 88.6), as were permanent complications (OR 0.169, 95% c.i. 0.073–0.391; P 0.001; I² = 74.7). Hematoma/seroma did not differ (OR 0.790, 95% c.i. 0.533–1.170; P = 0.24; I² = 0). Conclusions TT reduces locoregional recurrence but increases postoperative complications compared with LTT. For DTC 1–4 cm, surgical choice should balance oncologic control with complication risk and patient preferences.
Akbarpoor et al. (Sun,) studied this question.
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