Purpose The conventional surgical approach for isthmic papillary thyroid carcinoma (iPTC) has traditionally been total thyroidectomy. This study aimed to evaluate the prognosis and surgical efficacy of isthmusectomy in patients with clinically node-negative (cN0) solitary low-risk isthmic papillary thyroid microcarcinoma (iPTMC). Methods This study retrospectively analyzed 201 patients with cN0 solitary low-risk iPTMC who underwent isthmusectomy (IT group) and 374 who underwent total thyroidectomy (TT group) between January 2009 and January 2024. Clinicopathological features and surgical outcomes were compared. Recurrence-free survival (RFS) was assessed using the Kaplan–Meier method. Additionally, trends in surgical approaches for iPTMC were analyzed. Results The IT and TT groups showed significant differences in central lymph node metastasis (CLNM), microscopic, gross extrathyroidal extension (ETE) and median number of metastatic central lymph nodes (CLN) (p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). IT group had significantly lower incidences of postoperative hoarseness, transient and permanent hypocalcemia compared to the TT group (p < 0.001, p < 0.001, and p = 0.011, respectively). The median operative time in IT group was significantly shorter than in TT group (p < 0.001). The TT group was further divided into TTEI+ (with gross ETE) and TTEI− (without gross ETE) groups. Significant differences among the IT, TTEI-, and TTEI + groups were observed in median tumor size, CLNM, microscopic ETE (mETE) and median number of metastatic CLN (p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). Recurrence rates were 4.0%, 4.5%, and 9.3% in IT, TTEI−, and TTEI + groups (p = 0.067). RFS did not differ significantly between IT and TT groups (p = 0.305), but was significantly lower in TTEI + group than in TTEI − group (p = 0.023). Conclusion For cN0 solitary iPTMC patients, isthmusectomy demonstrated no apparent increase in recurrence risk within the follow-up period of this study and was associated with fewer complications and shorter operative time compared with total thyroidectomy. These findings support isthmusectomy as a potentially reasonable surgical option for carefully selected patients, pending further evaluation of long-term outcomes.

Prognosis and surgical outcomes of isthmusectomy for cN0 solitary Low-Risk papillary thyroid microcarcinoma in the isthmus

期刊论文
发表日期：

2026年2月16日

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Feng Zhu,
QiJun Zhang,
Shuai Dong,
XiaoJun Xie,
YiJun Wu

摘要

Purpose

The conventional surgical approach for isthmic papillary thyroid carcinoma (iPTC) has traditionally been total thyroidectomy. This study aimed to evaluate the prognosis and surgical efficacy of isthmusectomy in patients with clinically node-negative (cN0) solitary low-risk isthmic papillary thyroid microcarcinoma (iPTMC).

Methods

This study retrospectively analyzed 201 patients with cN0 solitary low-risk iPTMC who underwent isthmusectomy (IT group) and 374 who underwent total thyroidectomy (TT group) between January 2009 and January 2024. Clinicopathological features and surgical outcomes were compared. Recurrence-free survival (RFS) was assessed using the Kaplan–Meier method. Additionally, trends in surgical approaches for iPTMC were analyzed.

Results

The IT and TT groups showed significant differences in central lymph node metastasis (CLNM), microscopic, gross extrathyroidal extension (ETE) and median number of metastatic central lymph nodes (CLN) (p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). IT group had significantly lower incidences of postoperative hoarseness, transient and permanent hypocalcemia compared to the TT group (p < 0.001, p < 0.001, and p = 0.011, respectively). The median operative time in IT group was significantly shorter than in TT group (p < 0.001). The TT group was further divided into TTEI+ (with gross ETE) and TTEI− (without gross ETE) groups. Significant differences among the IT, TTEI-, and TTEI + groups were observed in median tumor size, CLNM, microscopic ETE (mETE) and median number of metastatic CLN (p < 0.001, p < 0.001, p < 0.001 and p < 0.001, respectively). Recurrence rates were 4.0%, 4.5%, and 9.3% in IT, TTEI−, and TTEI + groups (p = 0.067). RFS did not differ significantly between IT and TT groups (p = 0.305), but was significantly lower in TTEI + group than in TTEI − group (p = 0.023).

Conclusion

For cN0 solitary iPTMC patients, isthmusectomy demonstrated no apparent increase in recurrence risk within the follow-up period of this study and was associated with fewer complications and shorter operative time compared with total thyroidectomy. These findings support isthmusectomy as a potentially reasonable surgical option for carefully selected patients, pending further evaluation of long-term outcomes.