Innovative Approaches in Thyroid Cancer Surgery: A Comparative Study of Total vs. Partial Thyroidectomy; Systematic Review

摘要

Background: Thyroid cancer, predominantly papillary thyroid carcinoma (PTC), has seen a rising global incidence due to advancements in diagnostic techniques. Total thyroidectomy (TT) and partial thyroidectomy (PT), especially lobectomy, are the primary surgical treatments. Recent innovations, including robotic and endoscopic techniques, have reshaped the surgical landscape. Objective: This systematic review evaluates and compares TT and PT in the management of intermediate-risk PTC, emphasizing surgical outcomes, complications, recurrence, and the role of innovative approaches. Methods: A comprehensive search of PubMed, Embase, and Cochrane Library databases identified comparative studies up to April 2025. Eight retrospective cohort studies involving 2,984 patients were included. Key outcomes assessed were recurrence rates, surgical complications, and postoperative recovery metrics. Data were synthesized using RevMan 5.4 with subgroup and sensitivity analyses. Results: Recurrence rates were similar between TT and PT groups. PT demonstrated fewer overall complications, particularly transient hypocalcemia and recurrent laryngeal nerve palsy. Cosmetic satisfaction and recovery metrics favored PT. No significant difference was found in permanent complications or recurrence. The inclusion of minimally invasive and robotic techniques was associated with enhanced cosmetic and functional outcomes. Conclusions: Partial thyroidectomy offers comparable oncologic control to total thyroidectomy in appropriately selected patients with intermediate-risk PTC, with the added benefit of fewer complications and better postoperative quality of life. Ongoing innovation in surgical techniques further supports the shift toward conservative management when clinically appropriate.